Provider Demographics
NPI:1841923372
Name:GUTIERREZ-KENNEDY, JAZMIN (LPC)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:GUTIERREZ-KENNEDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JAZMIN
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2105 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2767
Mailing Address - Country:US
Mailing Address - Phone:504-512-0413
Mailing Address - Fax:
Practice Address - Street 1:4200 S I 10 SERVICE RD W STE 248
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1237
Practice Address - Country:US
Practice Address - Phone:504-512-0413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional