Provider Demographics
NPI:1407330715
Name:GUTIERREZ, TREASURE (MSW)
Entity Type:Individual
Prefix:
First Name:TREASURE
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S LAKE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2769
Mailing Address - Country:US
Mailing Address - Phone:213-905-2515
Mailing Address - Fax:
Practice Address - Street 1:2650 E FOOTHILL BLVD # 119
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3439
Practice Address - Country:US
Practice Address - Phone:626-577-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW84238208D00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice