Provider Demographics
NPI:1184484677
Name:GUTIERREZ, CYNTHIA GUADALUPE (LMFT, ATR)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GUADALUPE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 MACON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-6588
Mailing Address - Country:US
Mailing Address - Phone:310-940-1269
Mailing Address - Fax:
Practice Address - Street 1:742 MACON DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-6588
Practice Address - Country:US
Practice Address - Phone:310-940-1269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20-254221700000X
CA121964106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist