Provider Demographics
NPI:1598912172
Name:GUTIERREZ, LOUISA (CAC III)
Entity Type:Individual
Prefix:MS
First Name:LOUISA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 CALIFORNIA STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-1344
Mailing Address - Country:US
Mailing Address - Phone:303-295-6180
Mailing Address - Fax:303-295-0811
Practice Address - Street 1:2515 CALIFORNIA STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2929
Practice Address - Country:US
Practice Address - Phone:303-295-6180
Practice Address - Fax:303-295-0811
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1620-01101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)