Provider Demographics
NPI:1710405832
Name:GUTHRIE, STACIE NICOLE
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:NICOLE
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 W SAHARA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1981
Mailing Address - Country:US
Mailing Address - Phone:702-906-1330
Mailing Address - Fax:702-906-1339
Practice Address - Street 1:8170 W. SAHARA #203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-906-1330
Practice Address - Fax:702-906-1339
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV$$$$$$$$$Medicaid