Provider Demographics
NPI:1780491050
Name:GUTIERREZ, ALICIA
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 EUBANKS RD
Mailing Address - Street 2:
Mailing Address - City:COMBINE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-6040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 EUBANKS RD
Practice Address - Street 2:
Practice Address - City:COMBINE
Practice Address - State:TX
Practice Address - Zip Code:75159-6040
Practice Address - Country:US
Practice Address - Phone:469-865-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95009101YP2500X
TX000000101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty