Provider Demographics
NPI:1306682893
Name:GUTIERREZ, OLIVIA NMN (CADC)
Entity type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:NMN
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2422
Mailing Address - Country:US
Mailing Address - Phone:661-717-4811
Mailing Address - Fax:
Practice Address - Street 1:101 W 18TH ST
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2422
Practice Address - Country:US
Practice Address - Phone:661-717-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCADC-5071101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)