Provider Demographics
NPI:1396063632
Name:GUTHRIE, NORMAN MICHAEL (LMSW)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:MICHAEL
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 W COMMUNITY CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-4014
Mailing Address - Country:US
Mailing Address - Phone:605-760-3381
Mailing Address - Fax:
Practice Address - Street 1:1501 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3233
Practice Address - Country:US
Practice Address - Phone:580-889-3799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical