MEDICARE: PAUL GUTRECHT M.A., MFT 96168

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	106H00000X	Marriage & Family Therapist	96168	CA

General Provider Information

NPI Number	:	1467883538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL GUTRECHT M.A., MFT 96168

Provider Business Mailing Address
First Line	:	11664 NATIONAL BLVD UNIT 322
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3802
Country	:	US
Telephone Number	:	310-745-7712
Fax Number	:

Provider Business Practice Location Address
First Line	:	10780 SANTA MONICA BLVD STE 450
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7635
Country	:	US
Telephone Number	:	310-745-7712
Fax Number	:

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

Provider Enumeration Date	:	11/27/2013
Last Update Date	:	11/07/2018

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