Provider Demographics
NPI:1831559103
Name:GUTIERREZ, LISA J (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:J
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:JANE
Other - Last Name:CHRISTENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661
Mailing Address - Country:US
Mailing Address - Phone:989-965-2465
Mailing Address - Fax:
Practice Address - Street 1:105 N. 3RD ST.
Practice Address - Street 2:STE 6
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661
Practice Address - Country:US
Practice Address - Phone:989-965-2465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker