Healthcare Provider Details

I. General information

NPI: 1972864015
Provider Name (Legal Business Name): KRISTIN ANNE GAUTREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 MORRO RD STE 108
ATASCADERO CA
93422-4414
US

IV. Provider business mailing address

6370 NAVARETTE AVE
ATASCADERO CA
93422-3746
US

V. Phone/Fax

Practice location:
  • Phone: 805-550-0594
  • Fax:
Mailing address:
  • Phone: 805-550-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: