Provider Demographics
NPI:1104137843
Name:CHESTNUT-GUTIERREZ, JODI RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:RENEE
Last Name:CHESTNUT-GUTIERREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 N ZARAGOSA
Mailing Address - Street 2:B-4
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7905
Mailing Address - Country:US
Mailing Address - Phone:915-544-3500
Mailing Address - Fax:915-855-4404
Practice Address - Street 1:1514 ZARAGOSA
Practice Address - Street 2:B-4
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7905
Practice Address - Country:US
Practice Address - Phone:915-544-3500
Practice Address - Fax:915-855-4404
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical