Provider Demographics
NPI:1902009103
Name:GUTIERREZ, RAYMOND ALEXANDER (LCDC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ALEXANDER
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:A
Other - Last Name:GUTIERREZ
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LCDC
Mailing Address - Street 1:529 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-2971
Mailing Address - Country:US
Mailing Address - Phone:830-792-3300
Mailing Address - Fax:
Practice Address - Street 1:955 WATER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3508
Practice Address - Country:US
Practice Address - Phone:830-792-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9777101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)