Provider Demographics
NPI:1942606777
Name:GUTIERREZ, PAUL JR (MBA, MA, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:GUTIERREZ
Suffix:JR
Gender:M
Credentials:MBA, MA, LPC, NCC
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:E
Other - Last Name:GUTIERREZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:1401 POTTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3558
Mailing Address - Country:US
Mailing Address - Phone:719-660-6292
Mailing Address - Fax:719-683-9387
Practice Address - Street 1:1401 POTTER DR STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3500
Practice Address - Country:US
Practice Address - Phone:719-660-6292
Practice Address - Fax:719-683-9387
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 106H00000X
CO13204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1750702346Medicaid
CO1750702346Medicaid
CO1750702346Medicare PIN
CO1750702346Medicare NSC