Provider Demographics
NPI:1497539951
Name:GUTIERREZ, KIA KIM
Entity Type:Individual
Prefix:
First Name:KIA
Middle Name:KIM
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIA
Other - Middle Name:KIM
Other - Last Name:HUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1806 SPRINGFIELD PL NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5286
Mailing Address - Country:US
Mailing Address - Phone:360-520-2583
Mailing Address - Fax:
Practice Address - Street 1:1806 SPRINGFIELD PL NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5286
Practice Address - Country:US
Practice Address - Phone:360-520-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61466603106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist