Provider Demographics
NPI:1972311611
Name:GUSMAN, MONIQUE (LPC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:GUSMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 KERRVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-5605
Mailing Address - Country:US
Mailing Address - Phone:432-599-4228
Mailing Address - Fax:
Practice Address - Street 1:4115 KERRVILLE AVE
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-5605
Practice Address - Country:US
Practice Address - Phone:432-599-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97282101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor