Provider Demographics
NPI:1659891620
Name:GUTIERREZ, MARY BEL (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BEL
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 VENTURA BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2997
Mailing Address - Country:US
Mailing Address - Phone:818-788-2388
Mailing Address - Fax:818-788-3875
Practice Address - Street 1:15720 VENTURA BLVD STE 403
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2997
Practice Address - Country:US
Practice Address - Phone:818-788-2388
Practice Address - Fax:818-788-3875
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-25152103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst