Provider Demographics
NPI:1447823711
Name:NEHEMIAH R. GUTIERREZ, MED., LPC
Entity type:Organization
Organization Name:NEHEMIAH R. GUTIERREZ, MED., LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-733-7578
Mailing Address - Street 1:PO BOX 152331
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-2331
Mailing Address - Country:US
Mailing Address - Phone:210-704-7573
Mailing Address - Fax:
Practice Address - Street 1:10600 GARBACZ DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3771
Practice Address - Country:US
Practice Address - Phone:210-704-7573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty