Healthcare Provider Details

I. General information

NPI: 1336053503
Provider Name (Legal Business Name): BEDROCK PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W ILLINOIS ST
SPEARFISH SD
57783-2344
US

IV. Provider business mailing address

127 W ILLINOIS ST
SPEARFISH SD
57783-2344
US

V. Phone/Fax

Practice location:
  • Phone: 970-775-8655
  • Fax:
Mailing address:
  • Phone: 970-775-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMANTHA GUTHERLESS
Title or Position: LPC/ OWNER
Credential: MA, LPC
Phone: 720-662-9198