Provider Demographics
NPI:1760467716
Name:GUTIERREZ, TERESA M (LMHC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:M
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10689 N KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1525
Mailing Address - Country:US
Mailing Address - Phone:305-558-7400
Mailing Address - Fax:305-558-6134
Practice Address - Street 1:10689 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1525
Practice Address - Country:US
Practice Address - Phone:305-558-7400
Practice Address - Fax:305-558-6134
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health