Provider Demographics
NPI:1811382435
Name:GUSEWELLE, KATHY (MFT#17845)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:GUSEWELLE
Suffix:
Gender:F
Credentials:MFT#17845
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8054 VALENCIA ST STE D
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3984
Mailing Address - Country:US
Mailing Address - Phone:831-688-5796
Mailing Address - Fax:831-337-5797
Practice Address - Street 1:8054 VALENCIA ST STE D
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3984
Practice Address - Country:US
Practice Address - Phone:831-688-5796
Practice Address - Fax:831-337-5797
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17845106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist