MEDICARE: LILIANA MARIA GUTIERREZ LAC

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	LAC-23929	AZ

General Provider Information

NPI Number	:	1831049774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIANA MARIA GUTIERREZ LAC

Provider Business Mailing Address
First Line	:	5429 N 73RD LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-5734
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7420 E CAMELBACK RD STE 101
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-3509
Country	:	US
Telephone Number	:	480-256-2605
Fax Number	:	480-297-0100

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

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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