Provider Demographics
NPI:1083017933
Name:JOHNSON-GUTIERREZ, ELIZABETH AMY (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:AMY
Last Name:JOHNSON-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 1:2201 NW CORPORATE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7337
Mailing Address - Country:US
Mailing Address - Phone:561-499-6932
Mailing Address - Fax:561-235-5172
Practice Address - Street 1:2201 NW CORPORATE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7337
Practice Address - Country:US
Practice Address - Phone:561-499-6932
Practice Address - Fax:561-235-5172
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health