Provider Demographics
NPI:1366703324
Name:GUTHRIE, PAYTON GLEN
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:GLEN
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 1/2 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-4102
Mailing Address - Country:US
Mailing Address - Phone:580-367-5133
Mailing Address - Fax:
Practice Address - Street 1:424 1/2 N. 4TH
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-0000
Practice Address - Country:US
Practice Address - Phone:580-367-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health