Provider Demographics
NPI:1972716264
Name:GECHT, ELLEN (MFT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:GECHT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30100 CROWN VALLEY PKWY STE 17
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2041
Mailing Address - Country:US
Mailing Address - Phone:949-831-0939
Mailing Address - Fax:949-831-6123
Practice Address - Street 1:30100 CROWN VALLEY PKWY STE 17
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2041
Practice Address - Country:US
Practice Address - Phone:949-831-0939
Practice Address - Fax:949-831-6123
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC20900OtherLICENSE NUMBER