Provider Demographics
NPI:1154097020
Name:GEHLHAAR, KELLY J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:J
Last Name:GEHLHAAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160 RANCHO CARMEL DR STE 160 #1014
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4672
Mailing Address - Country:US
Mailing Address - Phone:858-367-3491
Mailing Address - Fax:
Practice Address - Street 1:16935 W BERNARDO DR STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1635
Practice Address - Country:US
Practice Address - Phone:858-367-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
CALCSW1020831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist