Provider Demographics
NPI:1275922056
Name:RAPALO GUTIERREZ, ELMER IVAN (LMFT 123821)
Entity Type:Individual
Prefix:
First Name:ELMER
Middle Name:IVAN
Last Name:RAPALO GUTIERREZ
Suffix:
Gender:M
Credentials:LMFT 123821
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 THE CITY DR S FL 2
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3205
Mailing Address - Country:US
Mailing Address - Phone:714-935-6363
Mailing Address - Fax:
Practice Address - Street 1:301 THE CITY DR S FL 2
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3205
Practice Address - Country:US
Practice Address - Phone:714-935-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT123821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist