Provider Demographics
NPI:1013558055
Name:GUZMAN, JONATHAN MICHAEL (MA, LPCC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 METRO BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3062
Mailing Address - Country:US
Mailing Address - Phone:612-268-5858
Mailing Address - Fax:612-268-5868
Practice Address - Street 1:1550 AMERICAN BLVD E STE 550
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-3100
Practice Address - Country:US
Practice Address - Phone:612-268-5858
Practice Address - Fax:612-268-5868
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3453101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional