=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598560948
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLEE GUTHRIE T-LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2025
-----------------------------------------------------
Last Update Date | 02/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 417 1ST AVE SE
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52314-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-777-1258
-----------------------------------------------------
Fax | 319-449-3585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1650 48TH ST
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52302-6060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-551-8760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 127285
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------