Healthcare Provider Details

I. General information

NPI: 1942795596
Provider Name (Legal Business Name): AIDYLEE GUZMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N CENTRAL AVE STE 700
PHOENIX AZ
85012-2806
US

IV. Provider business mailing address

3620 N 3RD ST
PHOENIX AZ
85012-2020
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-7373
  • Fax: 602-682-7455
Mailing address:
  • Phone: 602-230-7373
  • Fax: 602-682-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-19584
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5936
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: