Provider Demographics
NPI:1881822724
Name:GUTIERREZ, ADRIANA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:LYNN
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:LYNN
Other - Last Name:MATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:973 CRANNOG WAY
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-4133
Mailing Address - Country:US
Mailing Address - Phone:936-522-6072
Mailing Address - Fax:
Practice Address - Street 1:1855 LONGMIRE RD
Practice Address - Street 2:HILLTOP
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2001
Practice Address - Country:US
Practice Address - Phone:936-648-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional