MEDICARE: MRS. JENNY LEAH GUAJARDO M.ED., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4536	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952632747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY LEAH GUAJARDO M.ED., LPC

Provider Business Mailing Address
First Line	:	601 N RANDALL AVE
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-3345
Country	:	US
Telephone Number	:	580-243-9218
Fax Number	:	580-303-7977

Provider Business Practice Location Address
First Line	:	601 N RANDALL AVE
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-3345
Country	:	US
Telephone Number	:	580-243-9218
Fax Number	:	844-270-5692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	08/10/2021

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