Healthcare Provider Details

I. General information

NPI: 1336602366
Provider Name (Legal Business Name): CONSUELO M GUTIEREZ, LCSW DBA:HEALING BALANCE THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 GRAND AVE
BILLINGS MT
59101-5923
US

IV. Provider business mailing address

304 GRAND AVE
BILLINGS MT
59101-5923
US

V. Phone/Fax

Practice location:
  • Phone: 406-890-4016
  • Fax: 406-245-2441
Mailing address:
  • Phone: 406-890-4016
  • Fax: 406-245-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. CONSUELO M GUTIEREZ
Title or Position: LCSW
Credential: LCSW
Phone: 406-890-4016