Provider Demographics
NPI:1073232005
Name:GUTIERREZ, KATHERINE (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 22ND ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-5226
Mailing Address - Country:US
Mailing Address - Phone:239-601-4073
Mailing Address - Fax:
Practice Address - Street 1:9250 CORKSCREW RD STE 12
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3216
Practice Address - Country:US
Practice Address - Phone:239-601-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health