Provider Demographics
NPI:1245386127
Name:GUTIERREZ, MARTHA HELENA (MA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:HELENA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N STANLEY PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2991
Mailing Address - Country:US
Mailing Address - Phone:480-705-4512
Mailing Address - Fax:
Practice Address - Street 1:2140 E VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1324
Practice Address - Country:US
Practice Address - Phone:602-381-6120
Practice Address - Fax:602-381-6125
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool