MEDICARE: LORENA GUTIERREZ LPC

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	LPC-23301	AZ
2	101YP2500X	Professional Counselor	LPC-23301	AZ

General Provider Information

NPI Number	:	1699500470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORENA GUTIERREZ LPC

Provider Business Mailing Address
First Line	:	624 N HUMPHREYS ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 N 4TH ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-1812
Country	:	US
Telephone Number	:	928-624-5024
Fax Number	:

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

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	12/11/2025

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