Provider Demographics
NPI:1750654133
Name:GUTIERREZ, AMANDA (LMHC-QS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMHC-QS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9539 MIDER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4352
Mailing Address - Country:US
Mailing Address - Phone:305-458-9434
Mailing Address - Fax:
Practice Address - Street 1:92 SW 78TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2335
Practice Address - Country:US
Practice Address - Phone:305-458-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15111101Y00000X, 101YM0800X
101YP2500X, 251S00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program