Provider Demographics
NPI:1780122796
Name:OPEN DOORS COUNSELING, COACHING AND CONSULTING
Entity type:Organization
Organization Name:OPEN DOORS COUNSELING, COACHING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-499-9952
Mailing Address - Street 1:15351 W ACAPULCO LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-6055
Mailing Address - Country:US
Mailing Address - Phone:623-640-5635
Mailing Address - Fax:
Practice Address - Street 1:18444 N 25TH AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-1261
Practice Address - Country:US
Practice Address - Phone:602-499-9952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13271251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health