Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 13872 | TX |
NPI | 1003341025 |
---|---|
Provider Name | Mr. Nehemiah Ray Gutierrez |
First Address | Austin, TX 78704-2911 |
Second Address | Austin, TX 78744-2713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2017 |
Last Update Date | 27/04/2017 |