Provider Demographics
NPI:1245783687
Name:GUIDICATTI, KELSEY (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:GUIDICATTI
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:621 DOT WAY
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5808
Mailing Address - Country:US
Mailing Address - Phone:209-275-4834
Mailing Address - Fax:
Practice Address - Street 1:6707 EMBARCADERO DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-3382
Practice Address - Country:US
Practice Address - Phone:209-956-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist