Basic Information
| Provider Information | |||||||||
| NPI: | 1447629134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | JULIET | ||||||||
| MiddleName: | SEELEY | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LOVETT | ||||||||
| OtherFirstName: | JULIET | ||||||||
| OtherMiddleName: | SEELEY | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2577 NE COURTNEY DR | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977017638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413227500 | ||||||||
| FaxNumber: | 5413227565 | ||||||||
| Practice Location | |||||||||
| Address1: | 51340 HIGHWAY 97 | ||||||||
| Address2: | |||||||||
| City: | LA PINE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977399871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413227146 | ||||||||
| FaxNumber: | 5413227630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2015 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | L8142 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.