Basic Information
| Provider Information | |||||||||
| NPI: | 1093247884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10275 DOWDLE DR | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804038615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547018320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 S 21ST AVE | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806012581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036559065 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2017 | ||||||||
| LastUpdateDate: | 03/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NLC.0106508 | CO | Y | Agencies | Community/Behavioral Health |
No ID Information.