Healthcare Provider Details

I. General information

NPI: 1801634795
Provider Name (Legal Business Name): KARLA EVELINGH GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 GLENMOUNT PARK DR STE B
WEBSTER TX
77598-4368
US

IV. Provider business mailing address

12569 S 2700 W
RIVERTON UT
84065-7182
US

V. Phone/Fax

Practice location:
  • Phone: 281-407-5631
  • Fax:
Mailing address:
  • Phone: 801-209-9797
  • Fax: 801-206-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberUC-A6DFF62D-BBCF-4B8
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number95770
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number95770
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: