Provider Demographics
NPI:1851161947
Name:GUTIERREZ, SELMA ODETTE (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:SELMA
Middle Name:ODETTE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10419 FAIRLONG TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5859
Mailing Address - Country:US
Mailing Address - Phone:726-230-9208
Mailing Address - Fax:
Practice Address - Street 1:10419 FAIRLONG TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5859
Practice Address - Country:US
Practice Address - Phone:726-230-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional