Provider Demographics
NPI:1083142608
Name:TARA C GUTGESELL MA LPC LLC
Entity Type:Organization
Organization Name:TARA C GUTGESELL MA LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUTGESELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:215-836-1934
Mailing Address - Street 1:1407 BETHLEHEM PIKE FL 2
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1946
Mailing Address - Country:US
Mailing Address - Phone:215-836-1934
Mailing Address - Fax:215-836-1969
Practice Address - Street 1:1407 BETHLEHEM PIKE FL 2
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1946
Practice Address - Country:US
Practice Address - Phone:267-606-0046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty