Olivia NMN Gutierrez, CADC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Burley, ID
NPI 1306682893 · NPPES record last updated Jul 3, 2024
Key facts
- NPI
- 1306682893
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- CADC-5071 (ID)
- Practice address
- 101 W 18TH St
Burley, ID 83318-2422 - Phone
- (661) 717-4811
- NPI assigned
- Jul 3, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CADC-5071 | ID | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CADC-5071 | ID | Yes |
Addresses
Primary practice location
101 W 18TH St
Burley, ID 83318-2422
Mailing address
101 W 18TH St
Burley, ID 83318-2422
Phone (661) 717-4811
Other providers in Burley, ID
- Walter Maitland Graham
- Tyson Darrell Greener
- Joshua Ross Greenwell
- Nicholas P Greenwell
- Ashley Guercio
- Hansen Chiropractic and Neurology Health Center P C
- Jennifer Barton Hansen
- Lynn A Hansen
- Derek Harper
- Jeremy B Haymore
All providers in Burley, ID · Addiction (Substance Use Disorder) Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.