Basic Information
| Provider Information | |||||||||
| NPI: | 1568782001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUESMAN | ||||||||
| FirstName: | TOMMIE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | CPC,LPCC,CADC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1640 ALTA DR | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024746450 | ||||||||
| FaxNumber: | 7024746463 | ||||||||
| Practice Location | |||||||||
| Address1: | 1640 ALTA DR | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024746450 | ||||||||
| FaxNumber: | 7024746463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2010 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E 0501175 | OH | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | CP0067 | NV | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | CADC-I-01048 | NV | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.