Provider Demographics
NPI:1699823054
Name:GUTIERREZ, LYNDA (MA)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 MI TIERRA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3854
Mailing Address - Country:US
Mailing Address - Phone:805-922-0334
Mailing Address - Fax:805-922-6543
Practice Address - Street 1:4400 CATHEDRAL OAKS RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1042
Practice Address - Country:US
Practice Address - Phone:805-964-4710
Practice Address - Fax:805-964-4712
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACREDENTIAL103TS0200X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool