Active NPI
Sergio A Gutierrez, CADC II, QMHA II
- Addiction (Substance Use Disorder) Counselor
- Dallas, OR
National Provider Identifier
1376764951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 182 SW Academy Street
Dallas, OR 97338 - Phone
- (503) 623-9289
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | Primary |
Addresses
Primary practice location
182 SW Academy Street
Dallas, OR 97338
Mailing address
239 Stoneway Drive NW
Salem, OR 97304
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00-07-15 | Other | OR | CADC CERFTIFICATION NUMBE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729814400000",
"number": "1376764951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "239 STONEWAY DRIVE NW",
"city": "SALEM",
"state": "OR",
"postal_code": "97304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "182 SW ACADEMY STREET",
"city": "DALLAS",
"state": "OR",
"postal_code": "97338",
"telephone_number": "503-623-9289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTIERREZ",
"first_name": "SERGIO",
"middle_name": "A",
"credential": "CADC II, QMHA II",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2024-10-25",
"certification_date": "2024-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CADC CERFTIFICATION NUMBE",
"identifier": "00-07-15",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.