Provider Demographics
NPI:1316692437
Name:GUTIERREZ, MELISSA MARIE (LPCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 S LIVERMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4665
Mailing Address - Country:US
Mailing Address - Phone:925-321-6912
Mailing Address - Fax:
Practice Address - Street 1:454 S LIVERMORE AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4665
Practice Address - Country:US
Practice Address - Phone:925-321-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CA17228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional