Provider Demographics
NPI:1235293242
Name:GUTH, MARY T (LMFT, LPC-MH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:GUTH
Suffix:
Gender:F
Credentials:LMFT, LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 S WESTERN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6142
Mailing Address - Country:US
Mailing Address - Phone:605-951-8423
Mailing Address - Fax:605-274-1704
Practice Address - Street 1:3610 S WESTERN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6142
Practice Address - Country:US
Practice Address - Phone:605-951-8423
Practice Address - Fax:605-274-1704
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH101YM0800X
SDLMFT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575223Medicaid
MN478657100Medicaid
SD6575224Medicaid