Healthcare Provider Details

I. General information

NPI: 1396297503
Provider Name (Legal Business Name): KAREN L GUTHERLESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W WALKER ROAD
NORTH PLATTE NE
69101
US

IV. Provider business mailing address

401 W WALKER RD
NORTH PLATTE NE
69101-7837
US

V. Phone/Fax

Practice location:
  • Phone: 308-530-3622
  • Fax:
Mailing address:
  • Phone: 308-530-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KAREN L GUTHERLESS
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LIMHP CPC
Phone: 308-530-3622