Provider Demographics
NPI:1962969972
Name:GUTIERREZ, GABRIELLE MICHELLE (RBT)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MICHELLE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:MICHELLE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12230 KENCREST DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2665
Mailing Address - Country:US
Mailing Address - Phone:504-355-6899
Mailing Address - Fax:
Practice Address - Street 1:32 MILLBRANCH RD STE 40
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1673
Practice Address - Country:US
Practice Address - Phone:601-255-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician