Provider Demographics
NPI:1871510750
Name:GUTHRIE, PERRY THOMAS (PHD)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:THOMAS
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MOUNTAIN AVE
Mailing Address - Street 2:#243
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5176
Mailing Address - Country:US
Mailing Address - Phone:909-399-8718
Mailing Address - Fax:909-985-3992
Practice Address - Street 1:400 N MOUNTAIN AVE
Practice Address - Street 2:#243
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5176
Practice Address - Country:US
Practice Address - Phone:909-399-8718
Practice Address - Fax:909-985-3992
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7347103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist