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General NPI Number Information
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NPI Number | 1750587499
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Entity Type | Organization
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Legal Business Name | CHARLES ELIAS GUTIERREZ,PHD,LLC
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 8401 DATAPOINT DR STE 301
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5904
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Country | US
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Telephone | 210-354-1186
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Fax | 210-354-1187
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Provider Business Mailing Address
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Address Line | 8401 DATAPOINT DR STE 301
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5904
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Country | US
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Telephone | 210-354-1186
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Fax | 210-354-1187
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES E. GUTIERREZ
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Credential | PHD
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Telephone | 210-365-7481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31016
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License Number State | TX
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