Provider Demographics
NPI:1265805816
Name:GUTIERREZ, MICHAEL (MED, BCBA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8709 PALATINE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3621
Mailing Address - Country:US
Mailing Address - Phone:508-981-7160
Mailing Address - Fax:
Practice Address - Street 1:8709 PALATINE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3621
Practice Address - Country:US
Practice Address - Phone:508-981-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-12-10394103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst