Healthcare Provider Details

I. General information

NPI: 1093025546
Provider Name (Legal Business Name): MARIANA GUZMAN LMFT, LAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S MELROSE DR STE 105
VISTA CA
92081-6607
US

IV. Provider business mailing address

2200 BLISS CIR
OCEANSIDE CA
92056-3594
US

V. Phone/Fax

Practice location:
  • Phone: 760-978-8300
  • Fax: 888-292-0251
Mailing address:
  • Phone: 760-978-8300
  • Fax: 888-292-0251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLR02601116
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number80015
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: