MEDICARE: SYLWIA E GUTIERREZ MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPCC.0015273	CO
2	101YP2500X	Professional Counselor	LPC.0016838

General Provider Information

NPI Number	:	1609115518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLWIA E GUTIERREZ MA, LPC

Provider Business Mailing Address
First Line	:	4115 BOARDWALK DR UNIT 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5945
Country	:	US
Telephone Number	:	970-493-4580
Fax Number	:

Provider Business Practice Location Address
First Line	:	4115 BOARDWALK DR UNIT 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5945
Country	:	US
Telephone Number	:	970-493-4580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	03/30/2021

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