Healthcare Provider Details

I. General information

NPI: 1205730694
Provider Name (Legal Business Name): LAUREN GUTIERREZ VELEZ MS, CGC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S MADISON ST
TRAVERSE CITY MI
49684-2321
US

IV. Provider business mailing address

217 S MADISON ST
TRAVERSE CITY MI
49684-2321
US

V. Phone/Fax

Practice location:
  • Phone: 231-392-8522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number7201000710
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: