Provider Demographics
NPI:1437879681
Name:GUTIERREZ, ALYSSA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7719 BANYON AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3507
Mailing Address - Country:US
Mailing Address - Phone:505-948-6621
Mailing Address - Fax:
Practice Address - Street 1:4011 BARBARA LOOP SE STE 103
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87124-1040
Practice Address - Country:US
Practice Address - Phone:505-948-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-0729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health