Provider Demographics
NPI:1578752390
Name:GUTIERREZ, ADRIANA (MFT)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9522
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-9522
Mailing Address - Country:US
Mailing Address - Phone:661-874-8940
Mailing Address - Fax:661-794-7554
Practice Address - Street 1:44615 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3013
Practice Address - Country:US
Practice Address - Phone:661-874-8940
Practice Address - Fax:661-794-7554
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 79066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist