Provider Demographics
NPI:1811321151
Name:GUTIERREZ HERREN, DARIO (MA)
Entity type:Individual
Prefix:MR
First Name:DARIO
Middle Name:
Last Name:GUTIERREZ HERREN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:DARIO
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1323 S MICHIGAN AVE UNIT 705
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2625
Mailing Address - Country:US
Mailing Address - Phone:773-910-8808
Mailing Address - Fax:
Practice Address - Street 1:5239 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2122
Practice Address - Country:US
Practice Address - Phone:773-910-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health