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General NPI Number Information
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NPI Number | 1043512916
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Entity Type | Individual
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Provider Name | CANDACE M OLGUIN BS
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Gender | Female
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 1615 BONFORTE BLVD
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City | PUEBLO
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State | CO
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Zip | 81001-1602
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Country | US
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Telephone | 719-404-1992
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Fax |
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Provider Business Mailing Address
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Address Line | 4 MONTEBELLO RD
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City | PUEBLO
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State | CO
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Zip | 81001-1237
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Country | US
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Telephone | 719-546-6667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0018676
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License Number State | CO
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