Provider Demographics
NPI:1780193219
Name:GUTMANN, KELLYN RUTH ANN (LPCC)
Entity Type:Individual
Prefix:
First Name:KELLYN
Middle Name:RUTH ANN
Last Name:GUTMANN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BENMORE DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-7936
Mailing Address - Country:US
Mailing Address - Phone:408-515-3389
Mailing Address - Fax:
Practice Address - Street 1:150 BENMORE DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-7936
Practice Address - Country:US
Practice Address - Phone:408-515-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health