Provider Demographics
NPI:1801634795
Name:GUTIERREZ, KARLA EVELINGH
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:EVELINGH
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 S SHORE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2934
Mailing Address - Country:US
Mailing Address - Phone:832-932-3530
Mailing Address - Fax:409-750-7634
Practice Address - Street 1:2555 S SHORE BLVD STE C
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2934
Practice Address - Country:US
Practice Address - Phone:832-932-3530
Practice Address - Fax:409-750-7634
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXUC-A6DFF62D-BBCF-4B8171400000X
TX95770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171400000XOther Service ProvidersHealth & Wellness Coach