Healthcare Provider Details

I. General information

NPI: 1104656602
Provider Name (Legal Business Name): KEVIN GUZMAN ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 RESEDA BLVD
NORTHRIDGE CA
91324-4619
US

IV. Provider business mailing address

8330 RESEDA BLVD
NORTHRIDGE CA
91324-4619
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1051
  • Fax: 818-975-5072
Mailing address:
  • Phone: 818-996-1051
  • Fax: 213-241-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number141733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: