Provider Demographics
NPI:1962829838
Name:GUTIERREZ, PRISCILLA (LPC)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
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 1:1161 TOWER TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-1817
Mailing Address - Country:US
Mailing Address - Phone:915-472-8641
Mailing Address - Fax:915-542-4204
Practice Address - Street 1:1161 TOWER TRAIL LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-1817
Practice Address - Country:US
Practice Address - Phone:915-472-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional