Provider Demographics
NPI:1679374490
Name:GUIA, MICHAEL (LCDC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GUIA
Suffix:
Gender:
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 FREDERICKSBURG RD APT 232
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3598
Mailing Address - Country:US
Mailing Address - Phone:210-425-6487
Mailing Address - Fax:
Practice Address - Street 1:7122 SAN PEDRO AVE STE 114
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6233
Practice Address - Country:US
Practice Address - Phone:210-432-3700
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168881101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)