Healthcare Provider Details

I. General information

NPI: 1740124197
Provider Name (Legal Business Name): LISA MARIE GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E
MURRAY UT
84107-8100
US

IV. Provider business mailing address

174 E WILLIAMS AVE
SALT LAKE CITY UT
84111-4515
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-2602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: