Provider Demographics
NPI:1609437995
Name:GUTHRIE, IAN T (LPC)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:T
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-0053
Mailing Address - Country:US
Mailing Address - Phone:816-812-2081
Mailing Address - Fax:
Practice Address - Street 1:111 S RAYMORE ST
Practice Address - Street 2:
Practice Address - City:WOOD HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:64024-2828
Practice Address - Country:US
Practice Address - Phone:816-944-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016035081101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor