Provider Demographics
NPI:1497128870
Name:GUTIERREZ, AMELIA (IMFT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IMFT
Mailing Address - Street 1:5545 SW 8TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2287
Mailing Address - Country:US
Mailing Address - Phone:786-762-2952
Mailing Address - Fax:
Practice Address - Street 1:5545 SW 8TH ST STE 206
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2287
Practice Address - Country:US
Practice Address - Phone:786-762-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT2169101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor