Provider Demographics
NPI:1346830890
Name:GUTIERREZ, ANGELICA MARIA (SA61068019)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:SA61068019
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 E DENNY WAY UNIT 314
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5452
Mailing Address - Country:US
Mailing Address - Phone:206-483-9530
Mailing Address - Fax:
Practice Address - Street 1:2302 E DENNY WAY UNIT 314
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5452
Practice Address - Country:US
Practice Address - Phone:206-483-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASA61068019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health