Provider Demographics
NPI:1538839113
Name:GUTIERREZ, MICHELLE ANGELA (LPC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANGELA
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 1:8726 SPOONBILL ST
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-2849
Mailing Address - Country:US
Mailing Address - Phone:956-454-7614
Mailing Address - Fax:
Practice Address - Street 1:1305 S J ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6357
Practice Address - Country:US
Practice Address - Phone:956-454-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty