Provider Demographics
NPI:1467883538
Name:GUTRECHT, PAUL (MA, MFT 96168)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GUTRECHT
Suffix:
Gender:M
Credentials:MA, MFT 96168
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11664 NATIONAL BLVD UNIT 322
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3802
Mailing Address - Country:US
Mailing Address - Phone:310-745-7712
Mailing Address - Fax:
Practice Address - Street 1:10780 SANTA MONICA BLVD STE 450
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7635
Practice Address - Country:US
Practice Address - Phone:310-745-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist