Healthcare Provider Details

I. General information

NPI: 1336668136
Provider Name (Legal Business Name): JESSICA MARIE GUTIERREZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 03/23/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 SANT ANTONIO RD SUITE 100
MOUNTAIN VIEW CA
94040
US

IV. Provider business mailing address

PO BOX 412
SUISUN CITY CA
94585-0412
US

V. Phone/Fax

Practice location:
  • Phone: 669-257-3535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4892
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105694
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: