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General NPI Number Information
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NPI Number | 1336053503
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Entity Type | Organization
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Legal Business Name | BEDROCK PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 127 W ILLINOIS ST
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City | SPEARFISH
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State | SD
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Zip | 57783-2344
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Country | US
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Telephone | 970-775-8655
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Fax |
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Provider Business Mailing Address
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Address Line | 127 W ILLINOIS ST
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City | SPEARFISH
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State | SD
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Zip | 57783-2344
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Country | US
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Telephone | 970-775-8655
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Fax |
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Authorized Official
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Title or Position | LPC/ OWNER
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Name | SAMANTHA GUTHERLESS
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Credential | MA, LPC
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Telephone | 720-662-9198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | NULL
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