=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184333718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE GUGIU MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2022
-----------------------------------------------------
Last Update Date | 11/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 785 ERICKSEN AVE NE STE 117
-----------------------------------------------------
City | BAINBRIDGE ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98110-1874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-732-6370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 353 WALLACE WAY NE APT 13
-----------------------------------------------------
City | BAINBRIDGE ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98110-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-732-6370
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 86399
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------