Provider Demographics
NPI:1386179687
Name:GUTIERREZ, ALFONSO JR (CADC-CAS)
Entity Type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:
Last Name:GUTIERREZ
Suffix:JR
Gender:M
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 E KAWEAH AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-3309
Mailing Address - Country:US
Mailing Address - Phone:559-754-2705
Mailing Address - Fax:559-754-2708
Practice Address - Street 1:3107 E KAWEAH AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-3309
Practice Address - Country:US
Practice Address - Phone:559-754-2705
Practice Address - Fax:559-754-2708
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC033510315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)