MEDICARE: DAFNA GAUTHIER LPPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	102L00000X	Psychoanalyst	5915	CA

General Provider Information

NPI Number	:	1245651017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAFNA GAUTHIER LPPC

Provider Business Mailing Address
First Line	:	PO BOX 581984
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-0034
Country	:	US
Telephone Number	:	916-753-4479
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 30TH ST STE 306
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-3359
Country	:	US
Telephone Number	:	916-753-4479
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2013
Last Update Date	:	12/28/2021

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