Provider Demographics
NPI:1952573800
Name:BAILEY-GUTHERY, BERTJUANETTE JORICE (BA, BHRS, MS)
Entity Type:Individual
Prefix:
First Name:BERTJUANETTE
Middle Name:JORICE
Last Name:BAILEY-GUTHERY
Suffix:
Gender:F
Credentials:BA, BHRS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E CARDINAL PL
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-2517
Mailing Address - Country:US
Mailing Address - Phone:918-850-6019
Mailing Address - Fax:
Practice Address - Street 1:504 E CARDINAL PL
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-2517
Practice Address - Country:US
Practice Address - Phone:918-850-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor