Provider Demographics
NPI:1972308294
Name:GUADAMUZ, JOCELYN HAIDE
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:HAIDE
Last Name:GUADAMUZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 COUNTY ROAD 4846
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:TX
Mailing Address - Zip Code:76071-3131
Mailing Address - Country:US
Mailing Address - Phone:832-445-5142
Mailing Address - Fax:
Practice Address - Street 1:113 COUNTY ROAD 4846
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:TX
Practice Address - Zip Code:76071-3131
Practice Address - Country:US
Practice Address - Phone:832-445-5142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health