Provider Demographics
NPI:1902862659
Name:GUTHRIE, HEATHER (LCSW, LICSW, QMHP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:LCSW, LICSW, QMHP
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 1337
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-1337
Mailing Address - Country:US
Mailing Address - Phone:541-961-4226
Mailing Address - Fax:
Practice Address - Street 1:1523 SE HONEYSUCKLE LOOP
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-7418
Practice Address - Country:US
Practice Address - Phone:541-961-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORL7738101YM0800X, 1041C0700X
WALW61459551101YM0800X
COCSW9930701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0583984Medicaid
OR500748340Medicaid
ORR219077OtherMEDICARE