Provider Demographics
NPI:1386918571
Name:WUETHRICH, KATIE LYNN (MS)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:WUETHRICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 E GRAND AVE STE 103-422
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2421
Mailing Address - Country:US
Mailing Address - Phone:805-345-5671
Mailing Address - Fax:805-429-2678
Practice Address - Street 1:865 SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2805
Practice Address - Country:US
Practice Address - Phone:805-345-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF71112101YM0800X
CA86400101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health