Healthcare Provider Details

I. General information

NPI: 1104282763
Provider Name (Legal Business Name): JAQUELYN R GULDI MA, LPC, CAADC, CCTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 SHRESTHA DR STE D
BAY CITY MI
48706-2171
US

IV. Provider business mailing address

4151 SHRESTHA DR STE D
BAY CITY MI
48706-2171
US

V. Phone/Fax

Practice location:
  • Phone: 989-439-0004
  • Fax: 989-220-3409
Mailing address:
  • Phone: 989-439-0004
  • Fax: 989-220-3409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401019384
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-03854
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2-01388
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401017355
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: