MEDICARE: MS. MELISSA JO ANNE GUTIERREZ PSR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063744712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA JO ANNE GUTIERREZ PSR

Provider Business Mailing Address
First Line	:	2220 NORTH CLASSEN BLVD SUITE E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106
Country	:	US
Telephone Number	:	405-528-1748
Fax Number	:	405-528-1802

Provider Business Practice Location Address
First Line	:	2220 NORTH CLASSEN BLVD SUITE E
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6314
Country	:	US
Telephone Number	:	405-528-1748
Fax Number	:	405-528-1802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	03/17/2018

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