Healthcare Provider Details

I. General information

NPI: 1255142659
Provider Name (Legal Business Name): CAROLYN POPE GUZMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 HICKORY TREE RD
SAINT CLOUD FL
34772-8906
US

IV. Provider business mailing address

1123 MINNESOTA AVE
SAINT CLOUD FL
34769-3651
US

V. Phone/Fax

Practice location:
  • Phone: 321-805-4850
  • Fax:
Mailing address:
  • Phone: 407-572-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: