Provider Demographics
NPI:1710353768
Name:GUZMAN, BLANCA AIDE (LMFT)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:AIDE
Last Name:GUZMAN
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2540
Mailing Address - Country:US
Mailing Address - Phone:213-798-4595
Mailing Address - Fax:
Practice Address - Street 1:12501 CHANDLER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1955
Practice Address - Country:US
Practice Address - Phone:818-821-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT152068106H00000X
390200000X, 106H00000X
CA129789106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program