Provider Demographics
NPI:1275720161
Name:GUTIERREZ, BIBIANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BIBIANA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 PINON DR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-7507
Mailing Address - Country:US
Mailing Address - Phone:432-386-3223
Mailing Address - Fax:
Practice Address - Street 1:500 W AVENUE H
Practice Address - Street 2:SUITE 102E
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-6001
Practice Address - Country:US
Practice Address - Phone:432-386-3223
Practice Address - Fax:432-837-8104
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30732OtherSTATE MEDICAL LICENSE