MEDICARE: MRS. DIANA ANITA GUTIERREZ LMFT, LPCC

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	LPCC608	CA
2	106H00000X	Marriage & Family Therapist	MFC42095	CA

General Provider Information

NPI Number	:	1811008931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA ANITA GUTIERREZ LMFT, LPCC

Provider Business Mailing Address
First Line	:	2085 RUSTIN AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2498
Country	:	US
Telephone Number	:	951-452-1108
Fax Number	:

Provider Business Practice Location Address
First Line	:	2085 RUSTIN AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2498
Country	:	US
Telephone Number	:	951-955-7125
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/12/2021

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