Provider Demographics
NPI:1689097941
Name:STEPHANIE GUTZ, INC.
Entity Type:Organization
Organization Name:STEPHANIE GUTZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-779-3391
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-1077
Mailing Address - Country:US
Mailing Address - Phone:575-779-3391
Mailing Address - Fax:
Practice Address - Street 1:1219 GUSDORF RD
Practice Address - Street 2:SUITE E
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5402
Practice Address - Country:US
Practice Address - Phone:575-779-3391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-066021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty