Provider Demographics
NPI:1053930768
Name:GUTHRIE, TABITHA (LMSW)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:WISEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4801 E LINWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64128
Mailing Address - Country:US
Mailing Address - Phone:816-861-4700
Mailing Address - Fax:816-922-4838
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128
Practice Address - Country:US
Practice Address - Phone:816-861-4700
Practice Address - Fax:816-922-4838
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017044157104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker