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General NPI Number Information
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NPI Number | 1154097020
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Entity Type | Individual
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Provider Name | KELLY J GEHLHAAR LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 16935 W BERNARDO DR STE 208
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City | SAN DIEGO
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State | CA
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Zip | 92127-1635
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Country | US
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Telephone | 858-367-3491
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Fax |
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Provider Business Mailing Address
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Address Line | 11160 RANCHO CARMEL DR STE 160 #1014
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City | SAN DIEGO
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State | CA
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Zip | 92128-4672
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Country | US
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Telephone | 858-367-3491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW102083
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License Number State | CA
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