MEDICARE: DR. LEANN MARIA GUTIERREZ

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1518774439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEANN MARIA GUTIERREZ

Provider Business Mailing Address
First Line	:	3307 RUSHWOOD LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2281
Country	:	US
Telephone Number	:	562-619-5670
Fax Number	:

Provider Business Practice Location Address
First Line	:	3602 W DALLAS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-1704
Country	:	US
Telephone Number	:	713-284-8461
Fax Number	:

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

Provider Enumeration Date	:	12/13/2024
Last Update Date	:	12/13/2024

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