Provider Demographics
NPI:1952517344
Name:GUTIERREZ, MARY THERESE
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:THERESE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5232 SINGER RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5566
Mailing Address - Country:US
Mailing Address - Phone:505-640-9404
Mailing Address - Fax:
Practice Address - Street 1:5232 SINGER RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-5566
Practice Address - Country:US
Practice Address - Phone:505-640-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist