Provider Demographics
NPI:1629442678
Name:GUTIERREZ, IVONNE A (RMHCI)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 ALLEN LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1185
Mailing Address - Country:US
Mailing Address - Phone:407-416-1211
Mailing Address - Fax:
Practice Address - Street 1:2206 ALLEN LN
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1185
Practice Address - Country:US
Practice Address - Phone:407-416-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH12902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health