MEDICARE: MS. LORI GUTHRIE BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-15-19514	OK

General Provider Information

NPI Number	:	1336514579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI GUTHRIE BCBA

Provider Business Mailing Address
First Line	:	912 EXTER CIR
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-7682
Country	:	US
Telephone Number	:	405-517-5171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 S DOUGLAS BLVD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5210
Country	:	US
Telephone Number	:	855-908-5351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2015
Last Update Date	:	01/17/2025

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