Provider Demographics
NPI:1679868194
Name:GUTHRIDGE, JASON (BCABA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GUTHRIDGE
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24672 KIM CIR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4314
Mailing Address - Country:US
Mailing Address - Phone:949-357-4771
Mailing Address - Fax:949-357-4771
Practice Address - Street 1:24672 KIM CIR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4314
Practice Address - Country:US
Practice Address - Phone:949-357-4771
Practice Address - Fax:949-357-4771
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT1450812084P0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry