1225271992 NPI number — MR. LAURO GUZMAN LCSW

Table of content: (NPI 1679522213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225271992 NPI number — MR. LAURO GUZMAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUZMAN
Provider First Name:
LAURO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUZMAN
Provider Other First Name:
LARRY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225271992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14545 HERMIE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78552-2097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-970-5441
Provider Business Mailing Address Fax Number:
877-830-1667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 E JACKSON ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-970-5441
Provider Business Practice Location Address Fax Number:
877-830-1667
Provider Enumeration Date:
04/10/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  54345 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 54345 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 336901901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".