Organization
CHARLES ELIAS GUTIERREZ,PHD,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES E. GUTIERREZ PHD (OWNER)
(210) 365-7481
Entity
Organization
Contact information
Practice address
8401 DATAPOINT DR STE 301, SAN ANTONIO, TX 78229-5904
(210) 354-1186
(210) 354-1187
Mailing address
8401 DATAPOINT DR STE 301, SAN ANTONIO, TX 78229-5904
(210) 354-1186
(210) 354-1187
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
31016
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0093QA
BLUE CROSS BLUE SHIELD
TX
01
—
1049038
CIGNA
TX
05
—
189691202
—
TX
Enumeration date
06/21/2007
Last updated
06/12/2023
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