Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | MCAP100136 | FL |
N | 101YM0800X | Mental Health Counselor | IMH15395 | FL |
Y | 101YM0800X | Mental Health Counselor | MH19283 | FL |
NPI | 1003319971 |
---|---|
Provider Name | Diana Guzman |
First Address | Royal Palm Beach, FL 33411-5001 |
Second Address | Royal Palm Beach, FL 33411-5001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2018 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MH19283 | LICENSE (01) | FL |