Healthcare Provider Details

I. General information

NPI: 1699500470
Provider Name (Legal Business Name): LORENA GUTIERREZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 N 4TH ST
FLAGSTAFF AZ
86004-1812
US

IV. Provider business mailing address

624 N HUMPHREYS ST
FLAGSTAFF AZ
86001-3070
US

V. Phone/Fax

Practice location:
  • Phone: 928-624-5024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-23301
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-23301
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: