Provider Demographics
NPI:1851712574
Name:GUTIERREZ, MICHAEL (BCBA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 HANSEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1219
Mailing Address - Country:US
Mailing Address - Phone:575-649-7174
Mailing Address - Fax:
Practice Address - Street 1:801 HANSEN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1219
Practice Address - Country:US
Practice Address - Phone:575-649-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1-13-14451103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst