Healthcare Provider Details

I. General information

NPI: 1750415121
Provider Name (Legal Business Name): ELIZABETH TARA GEHLER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1679 E MAIN ST STE 102
EL CAJON CA
92021-5212
US

IV. Provider business mailing address

1679 E MAIN ST STE 102
EL CAJON CA
92021-5212
US

V. Phone/Fax

Practice location:
  • Phone: 619-441-1907
  • Fax:
Mailing address:
  • Phone: 619-441-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number48833
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: