Provider Demographics
NPI:1841841723
Name:GUTIERREZ, DANIELLE N (LPC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:N
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 RICHARDSON HWY APT 3
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5967
Mailing Address - Country:US
Mailing Address - Phone:808-226-1222
Mailing Address - Fax:
Practice Address - Street 1:1528 RICHARDSON HWY APT 3
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-5967
Practice Address - Country:US
Practice Address - Phone:808-226-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015752101YP2500X
AK136636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional