Healthcare Provider Details

I. General information

NPI: 1124477955
Provider Name (Legal Business Name): STACEY DENISE GUTHRIE LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9761 DOROTHY DR
OLIVE BRANCH MS
38654-6598
US

IV. Provider business mailing address

8626 AIRWAYS BLVD
SOUTHAVEN MS
38671-2603
US

V. Phone/Fax

Practice location:
  • Phone: 901-412-2720
  • Fax:
Mailing address:
  • Phone: 662-772-5937
  • Fax: 662-772-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1239
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1239
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1239
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: