Provider Demographics
NPI:1427623206
Name:GUTHRIE, BRYAN (MS LMFT LEP)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:MS LMFT LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16421 UNDERHILL LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3331
Mailing Address - Country:US
Mailing Address - Phone:714-401-6724
Mailing Address - Fax:
Practice Address - Street 1:6 VENTURE STE 350
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-7350
Practice Address - Country:US
Practice Address - Phone:714-401-6724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40636106H00000X
CA3612103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist