Provider Demographics
NPI:1134681356
Name:GUTIERREZ, PAM SUE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PAM
Middle Name:SUE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9644 BUCKINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-1527
Mailing Address - Country:US
Mailing Address - Phone:248-613-5032
Mailing Address - Fax:
Practice Address - Street 1:29540 SOUTHFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2047
Practice Address - Country:US
Practice Address - Phone:248-506-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional