Provider Demographics
NPI:1538811641
Name:GUTHRIE, ETHAN CHRISTOPHER (RBT)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:CHRISTOPHER
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 1ST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5756
Mailing Address - Country:US
Mailing Address - Phone:843-709-3992
Mailing Address - Fax:888-808-4249
Practice Address - Street 1:1820 1ST DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5756
Practice Address - Country:US
Practice Address - Phone:843-709-3992
Practice Address - Fax:888-808-4249
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician