Provider Demographics
NPI:1093584856
Name:GUTSHALL, PAULA GRACE
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:GRACE
Last Name:GUTSHALL
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 1:1900 RASPBERRY CT NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-8025
Mailing Address - Country:US
Mailing Address - Phone:505-414-5579
Mailing Address - Fax:
Practice Address - Street 1:1900 RASPBERRY CT NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-8025
Practice Address - Country:US
Practice Address - Phone:505-414-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician