Provider Demographics
NPI:1083663116
Name:GUTRIDGE, THOMAS R (LPC-MHSP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:GUTRIDGE
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 MINERAL SPRINGS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1549
Mailing Address - Country:US
Mailing Address - Phone:865-688-0661
Mailing Address - Fax:865-688-5780
Practice Address - Street 1:2507 MINERAL SPRINGS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1549
Practice Address - Country:US
Practice Address - Phone:865-688-0661
Practice Address - Fax:865-688-5780
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC-164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional