MEDICARE: MR. DARIO GUTIERREZ HERREN M.A.

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	180.008073	IL

General Provider Information

NPI Number	:	1811321151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARIO GUTIERREZ HERREN M.A.

Provider Business Mailing Address
First Line	:	1323 S MICHIGAN AVE UNIT 705
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2625
Country	:	US
Telephone Number	:	773-910-8808
Fax Number	:

Provider Business Practice Location Address
First Line	:	5239 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2122
Country	:	US
Telephone Number	:	773-910-8808
Fax Number	:

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

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	07/02/2021

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