Healthcare Provider Details

I. General information

NPI: 1659236750
Provider Name (Legal Business Name): KENDRA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 TOEPPERWEIN RD STE 1202
LIVE OAK TX
78233-3159
US

IV. Provider business mailing address

185 LARK HILL RD
FLORESVILLE TX
78114-6613
US

V. Phone/Fax

Practice location:
  • Phone: 210-951-3479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number100810
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: