Provider Demographics
NPI:1407160070
Name:PALACIOS-GUTIERREZ, CYNTHIA E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:E
Last Name:PALACIOS-GUTIERREZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:E
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3760 S HIGHLAND DR STE 354
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4260
Mailing Address - Country:US
Mailing Address - Phone:385-260-0181
Mailing Address - Fax:
Practice Address - Street 1:3760 S HIGHLAND DR STE 354
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-4260
Practice Address - Country:US
Practice Address - Phone:385-260-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
UT9187320-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9187320-2501OtherDIVISION OF OCCUPATIONAL & PROFESSIONAL LICENSING