Provider Demographics
NPI:1306099601
Name:GUTGESELL, TARA C (MA, LPC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:C
Last Name:GUTGESELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 E ALLENS LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1105
Mailing Address - Country:US
Mailing Address - Phone:267-606-0046
Mailing Address - Fax:610-644-4066
Practice Address - Street 1:632 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1641
Practice Address - Country:US
Practice Address - Phone:610-825-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00316500101YP2500X
PAPC003600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional