Healthcare Provider Details

I. General information

NPI: 1518598655
Provider Name (Legal Business Name): MICHELLE GUZMAN MHCS 1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400K EMELINE AVE
SANTA CRUZ CA
95060-1976
US

IV. Provider business mailing address

1400 EMELINE AVE # K
SANTA CRUZ CA
95060-1976
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-4900
  • Fax: 831-425-1847
Mailing address:
  • Phone: 831-454-4900
  • Fax: 831-425-4916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10335
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10335
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number10335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: