1003341025 NPI number — MR. NEHEMIAH RAY GUTIERREZ LPC

Table of content: MR. NEHEMIAH RAY GUTIERREZ LPC (NPI 1003341025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003341025 NPI number — MR. NEHEMIAH RAY GUTIERREZ LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTIERREZ
Provider First Name:
NEHEMIAH
Provider Middle Name:
RAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUTIERREZ
Provider Other First Name:
NEHEMIAS
Provider Other Middle Name:
RAY
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCDC, LPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003341025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 152331
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78715-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-704-7573
Provider Business Mailing Address Fax Number:
512-703-1394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 S LAMAR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-8962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-445-7700
Provider Business Practice Location Address Fax Number:
512-703-1394
Provider Enumeration Date:
04/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  78738 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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