Healthcare Provider Details

I. General information

NPI: 1700244084
Provider Name (Legal Business Name): ZACHARY L GUZMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E LAS ANIMAS ST
COLORADO SPRINGS CO
80903-4422
US

IV. Provider business mailing address

17 FARRAGUT AVE
COLORADO SPRINGS CO
80909-5625
US

V. Phone/Fax

Practice location:
  • Phone: 928-853-5019
  • Fax:
Mailing address:
  • Phone: 719-327-2059
  • Fax: 719-636-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09926062
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: