Provider Demographics
NPI:1457897670
Name:GUTIEREZ, CONSUELO M (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:M
Last Name:GUTIEREZ
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2518
Mailing Address - Country:US
Mailing Address - Phone:406-890-4016
Mailing Address - Fax:
Practice Address - Street 1:304 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-5923
Practice Address - Country:US
Practice Address - Phone:406-890-4016
Practice Address - Fax:406-245-2441
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28860104100000X
MTBBH-LCSW-LIC-226601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker