Provider Demographics
NPI:1073395943
Name:GUTIERREZ ALAYO, THAIS I
Entity Type:Individual
Prefix:PROF
First Name:THAIS
Middle Name:
Last Name:GUTIERREZ ALAYO
Suffix:I
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 1:11044 DAWNVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7421
Mailing Address - Country:US
Mailing Address - Phone:407-456-6713
Mailing Address - Fax:
Practice Address - Street 1:2901 E IRLO BRONSON MEMORIAL HWY STE D
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5600
Practice Address - Country:US
Practice Address - Phone:404-483-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health