Basic Information
| Provider Information | |||||||||
| NPI: | 1851643282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTIERREZ | ||||||||
| FirstName: | RUBEN | ||||||||
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| Credential: | M.A., L.M.F.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27305 LIVE OAK RD STE A | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913844520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613101525 | ||||||||
| FaxNumber: | 3103985690 | ||||||||
| Practice Location | |||||||||
| Address1: | 27201 TOURNEY RD STE 201K | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913551804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613101525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2012 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT96985 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.