Provider Demographics
NPI:1841025087
Name:GUTIERREZ VAZQUEZ, CECILIA MARIA
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:MARIA
Last Name:GUTIERREZ VAZQUEZ
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 1:6321 N KLAMM RD UNIT 331
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2449
Mailing Address - Country:US
Mailing Address - Phone:913-831-6499
Mailing Address - Fax:
Practice Address - Street 1:2121 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2126
Practice Address - Country:US
Practice Address - Phone:816-471-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022041618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health