Healthcare Provider Details

I. General information

NPI: 1225949274
Provider Name (Legal Business Name): SAMUEL LOUIS GUTHRIE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 VERSAILLES CIR APT F
TOWSON MD
21204-6925
US

IV. Provider business mailing address

129 VERSAILLES CIR APT F
TOWSON MD
21204-6925
US

V. Phone/Fax

Practice location:
  • Phone: 443-821-8930
  • Fax:
Mailing address:
  • Phone: 443-821-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number35085
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: