Provider Demographics
NPI:1538449418
Name:GUTEN, MIYA R (LCSW)
Entity type:Individual
Prefix:MS
First Name:MIYA
Middle Name:R
Last Name:GUTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 9TH ST N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1104
Mailing Address - Country:US
Mailing Address - Phone:727-687-7969
Mailing Address - Fax:727-498-8605
Practice Address - Street 1:6161 9TH ST N
Practice Address - Street 2:SUITE 201
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703
Practice Address - Country:US
Practice Address - Phone:727-687-7969
Practice Address - Fax:727-498-8605
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 98351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical