Provider Demographics
NPI:1063744712
Name:GUTIERREZ, MELISSA JO ANNE (PSR)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JO ANNE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PSR
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:PARKER
Other - Last Name:FRONTERHOUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PRS
Mailing Address - Street 1:2220 NORTH CLASSEN BLVD SUITE E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106
Mailing Address - Country:US
Mailing Address - Phone:405-528-1748
Mailing Address - Fax:405-528-1802
Practice Address - Street 1:2220 NORTH CLASSEN BLVD SUITE E
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6314
Practice Address - Country:US
Practice Address - Phone:405-528-1748
Practice Address - Fax:405-528-1802
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health