Provider Demographics
NPI:1376991315
Name:GUTIERREZ, KARIN KERSTIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:KERSTIN
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:KARIN
Other - Middle Name:KERSTIN
Other - Last Name:THULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 JOHNSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-744-9470
Mailing Address - Fax:866-727-0774
Practice Address - Street 1:1107 JOHNSON AVENUE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-744-9470
Practice Address - Fax:866-727-0774
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18269103TC0700X
103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy