Healthcare Provider Details

I. General information

NPI: 1710101464
Provider Name (Legal Business Name): CATHANN DRAGONE-GUTIERREZ MA LPC NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 SAN MATEO BLVD NE S-14
ALBUQUERQUE NM
87110-4058
US

IV. Provider business mailing address

1015 MONROE ST NE
ALBUQUERQUE NM
87110-5821
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-1871
  • Fax:
Mailing address:
  • Phone: 505-307-1059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0093771
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0093771
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0093771
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number0093771
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: