Provider Demographics
NPI:1467872101
Name:MARY T. GUTH
Entity Type:Organization
Organization Name:MARY T. GUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:GUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:605-951-8423
Mailing Address - Street 1:3610 S WESTERN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6143
Mailing Address - Country:US
Mailing Address - Phone:605-951-8423
Mailing Address - Fax:605-274-1704
Practice Address - Street 1:1605 E 63RD ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-4759
Practice Address - Country:US
Practice Address - Phone:605-951-8423
Practice Address - Fax:605-274-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH 2006261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)