Provider Demographics
NPI:1508688268
Name:GUTTERMAN, ALEXANDER PALACHE (LPCC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:PALACHE
Last Name:GUTTERMAN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MAIN CT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1851
Mailing Address - Country:US
Mailing Address - Phone:218-349-9610
Mailing Address - Fax:
Practice Address - Street 1:811 MAIN CT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1851
Practice Address - Country:US
Practice Address - Phone:218-349-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPCC.0020050OtherSTATE OF CORADO