Healthcare Provider Details

I. General information

NPI: 1649250457
Provider Name (Legal Business Name): LAURA M GUISE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/07/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 OTTER TRL
SEBRING FL
33875-6329
US

IV. Provider business mailing address

297 OTTER TRL
SEBRING FL
33875-6329
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-3279
  • Fax: 317-300-7143
Mailing address:
  • Phone: 317-296-3279
  • Fax: 317-300-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001578A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20778
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000302A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: