Healthcare Provider Details

I. General information

NPI: 1952803330
Provider Name (Legal Business Name): MERCEDES GUTIERREZ LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

IV. Provider business mailing address

4123 MARSEILLE DR
SAINT LOUIS MO
63129-3427
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-7491
  • Fax:
Mailing address:
  • Phone: 314-283-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: