Healthcare Provider Details

I. General information

NPI: 1013558055
Provider Name (Legal Business Name): JONATHAN MICHAEL GUZMAN MA, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 AMERICAN BLVD E STE 550
BLOOMINGTON MN
55425-3100
US

IV. Provider business mailing address

7401 METRO BLVD STE 250
EDINA MN
55439-3062
US

V. Phone/Fax

Practice location:
  • Phone: 612-268-5858
  • Fax: 612-268-5868
Mailing address:
  • Phone: 612-268-5858
  • Fax: 612-268-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3453
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3453
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: