Healthcare Provider Details

I. General information

NPI: 1215602016
Provider Name (Legal Business Name): KENIA LIZETHE GUTIERREZ AVELINO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4565 CALIFORNIA AVE
LONG BEACH CA
90807-1507
US

IV. Provider business mailing address

1735 N WILLOW WOODS DR UNIT D
ANAHEIM CA
92807-1457
US

V. Phone/Fax

Practice location:
  • Phone: 565-422-8472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20419
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: