MEDICARE: PHYLLIS GUTHUA PSY.D.

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	103TC0700X	Clinical Psychologist	06176	MD

General Provider Information

NPI Number	:	1427528900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS GUTHUA PSY.D.

Provider Business Mailing Address
First Line	:	1620 PROVIDENCE RD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-1525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 PROVIDENCE RD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-1525
Country	:	US
Telephone Number	:	410-517-5408
Fax Number	:

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

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	06/11/2026

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