Provider Demographics
NPI:1124038252
Name:GUTHRIE, BILLY JOE (MASTER OF SOCIAL WOR)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JOE
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:MASTER OF SOCIAL WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 CLIFFS LND
Mailing Address - Street 2:#101B
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198
Mailing Address - Country:US
Mailing Address - Phone:734-483-8774
Mailing Address - Fax:
Practice Address - Street 1:33101 ANNAPOLIS
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48186
Practice Address - Country:US
Practice Address - Phone:734-721-0200
Practice Address - Fax:734-721-2008
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801012527104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker