Provider Demographics
NPI:1366056327
Name:GUZMAN SANJURJO, GUSTAVO ANTONIO (LMHC)
Entity type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:ANTONIO
Last Name:GUZMAN SANJURJO
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16A PROSPERITY LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7409
Mailing Address - Country:US
Mailing Address - Phone:407-450-5985
Mailing Address - Fax:
Practice Address - Street 1:303 COMMERCE CENTER DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-1549
Practice Address - Country:US
Practice Address - Phone:407-450-5985
Practice Address - Fax:407-604-6883
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18306101YS0200X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool