Healthcare Provider Details

I. General information

NPI: 1528281417
Provider Name (Legal Business Name): BERNADETTE GUIDRY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 CATAMOUNT PARK
MIDDLEBURY VT
05753-1292
US

IV. Provider business mailing address

672 W 11TH ST STE 337
TRACY CA
95376-3821
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-7185
  • Fax:
Mailing address:
  • Phone: 209-627-8345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.LF.61220617
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 50705
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number100-0133998
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5152-R
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: