Provider Demographics
NPI:1598555765
Name:GUTIERREZ, MARC (AA)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 MEDICAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7904
Mailing Address - Country:US
Mailing Address - Phone:512-910-3469
Mailing Address - Fax:
Practice Address - Street 1:1603 MEDICAL PKWY STE 1001603
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7899
Practice Address - Country:US
Practice Address - Phone:512-910-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician