Healthcare Provider Details

I. General information

NPI: 1023538550
Provider Name (Legal Business Name): LAURA GUTIERREZ B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 W 5TH AVE
EUGENE OR
97402-5106
US

IV. Provider business mailing address

1006 N VIALL RD
GRANDVIEW WA
98930-9485
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-2667
  • Fax:
Mailing address:
  • Phone: 509-882-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: