Healthcare Provider Details

I. General information

NPI: 1689176448
Provider Name (Legal Business Name): PHILLIP MICHAEL GUTTMANN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S HILL ST APT 404
LOS ANGELES CA
90015-4310
US

IV. Provider business mailing address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

V. Phone/Fax

Practice location:
  • Phone: 917-837-4377
  • Fax:
Mailing address:
  • Phone: 213-381-2931
  • Fax: 213-381-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number75930
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: