Provider Demographics
NPI:1477745719
Name:GUTERSON, DORI TAYLOR (LICSW, MHP, CMHS)
Entity Type:Individual
Prefix:MRS
First Name:DORI
Middle Name:TAYLOR
Last Name:GUTERSON
Suffix:
Gender:F
Credentials:LICSW, MHP, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 179TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-5534
Mailing Address - Country:US
Mailing Address - Phone:206-321-9998
Mailing Address - Fax:206-299-4651
Practice Address - Street 1:7320 179TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-5534
Practice Address - Country:US
Practice Address - Phone:206-321-9998
Practice Address - Fax:206-299-4651
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLW00009392101Y00000X
WALW00009392101YM0800X, 101YP2500X, 1041C0700X, 106H00000X
101YM0800X, 106H00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00009392OtherWA DEPT. OF HEALTH
WA2039295Medicaid
13558962OtherCAQH