Basic Information
| Provider Information | |||||||||
| NPI: | 1518365576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUFFEY | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6655 E US HIGHWAY 36 | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461238923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172723330 | ||||||||
| FaxNumber: | 3172720807 | ||||||||
| Practice Location | |||||||||
| Address1: | 6655 E US HIGHWAY 36 | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461238923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172723330 | ||||||||
| FaxNumber: | 3172720807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2014 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 33006747A | IN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.