Basic Information
| Provider Information | |||||||||
| NPI: | 1750757241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | LIBERTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1912 65TH PL NE | ||||||||
| Address2: | |||||||||
| City: | TULALIP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982719136 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | COMPASS HEALTH EVERETT, WA 98213 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253498359 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2015 | ||||||||
| LastUpdateDate: | 08/19/2015 | ||||||||
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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 | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.