Healthcare Provider Details

I. General information

NPI: 1154097020
Provider Name (Legal Business Name): KELLY J GEHLHAAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 IBERIA PL STE 135
SAN DIEGO CA
92128-2456
US

IV. Provider business mailing address

11160 RANCHO CARMEL DR STE 160 #1014
SAN DIEGO CA
92128-4672
US

V. Phone/Fax

Practice location:
  • Phone: 858-367-3491
  • Fax: 858-524-5942
Mailing address:
  • Phone: 858-367-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW102083
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: