Provider Demographics
NPI:1871305631
Name:GUTIERREZ, TANYA LISETT (AMFT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LISETT
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 EL CABRILLO
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3220
Mailing Address - Country:US
Mailing Address - Phone:714-603-9140
Mailing Address - Fax:
Practice Address - Street 1:573 EL CABRILLO
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3220
Practice Address - Country:US
Practice Address - Phone:714-603-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT152697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist