Provider Demographics
NPI:1316241177
Name:GUTIERREZ, JEANNETTE ALICIA (LMHC)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:ALICIA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10135 STONEWAY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-6929
Mailing Address - Country:US
Mailing Address - Phone:915-373-6642
Mailing Address - Fax:
Practice Address - Street 1:10135 STONEWAY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6929
Practice Address - Country:US
Practice Address - Phone:915-373-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0136401101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health