Active NPI
Eva Gutierrez Ackerely, TCADC
- Addiction (Substance Use Disorder) Counselor
- Mason City, IA
National Provider Identifier
1205593282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- T21112
- Practice address
- 320 N Eisenhower Ave
Mason City, IA 50401-1521 - Phone
- (641) 424-2391
- Fax
- (641) 424-0783
- NPI assigned
- Nov 24, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | T21112 | IA | Primary |
Addresses
Primary practice location
320 N Eisenhower Ave
Mason City, IA 50401-1521
Mailing address
320 N Eisenhower Ave
Mason City, IA 50401-1521
Phone (641) 424-2391
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952443632 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T21112 | IA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637712000000",
"number": "1205593282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 N EISENHOWER AVE",
"city": "MASON CITY",
"state": "IA",
"postal_code": "504011521",
"telephone_number": "641-424-2391",
"fax_number": "641-424-0783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 N EISENHOWER AVE",
"city": "MASON CITY",
"state": "IA",
"postal_code": "504011521",
"telephone_number": "641-424-2391",
"fax_number": "641-424-0783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTIERREZ ACKERELY",
"first_name": "EVA",
"credential": "TCADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-24",
"last_updated": "2021-11-24",
"certification_date": "2021-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IA",
"license": "T21112",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1952443632",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mason City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.