Individual
JOHN GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
477 E BROADWAY ROAD, APACHE JUNCTION, AZ 85219
(480) 983-0562
(480) 983-0635
Mailing address
PO BOX 3160, APACHE JUNCTION, AZ 85217-3160
(480) 983-0065
(480) 983-0635
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0695
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW 0695
MEDICAID AND MEDICARE PENDING
AZ
05
—
PENDING
—
AZ
Enumeration date
06/16/2009
Last updated
07/10/2009
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