Provider Demographics
NPI:1386024602
Name:UTTING, GEMMA (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:GEMMA
Middle Name:
Last Name:UTTING
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N MOBLEY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8137
Mailing Address - Country:US
Mailing Address - Phone:208-340-8989
Mailing Address - Fax:
Practice Address - Street 1:424 N MOBLEY DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-8137
Practice Address - Country:US
Practice Address - Phone:208-340-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5704106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist