Healthcare Provider Details

I. General information

NPI: 1073232005
Provider Name (Legal Business Name): KATHERINE GUTIERREZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 CORKSCREW RD STE 12
ESTERO FL
33928-3216
US

IV. Provider business mailing address

3410 22ND ST W
LEHIGH ACRES FL
33971-5226
US

V. Phone/Fax

Practice location:
  • Phone: 239-601-4073
  • Fax:
Mailing address:
  • Phone: 239-601-4073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: