Healthcare Provider Details

I. General information

NPI: 1770078115
Provider Name (Legal Business Name): NAOMI GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/19/2024
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 3RD ST
GRETNA LA
70053-5805
US

IV. Provider business mailing address

847 3RD ST
GRETNA LA
70053-5805
US

V. Phone/Fax

Practice location:
  • Phone: 504-814-4480
  • Fax:
Mailing address:
  • Phone: 504-814-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6364
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: