Basic Information
| Provider Information | |||||||||
| NPI: | 1548225758 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTJAHR | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 N MARR RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472016660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123143400 | ||||||||
| FaxNumber: | 8123788367 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 N MARR RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472016660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123143400 | ||||||||
| FaxNumber: | 8123788367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 02/28/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 99029520A | IN | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.