Provider Demographics
NPI:1518857077
Name:GUTIERREZ, GEORGE G (LICSW)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:G
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 TACOMA MALL BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-9001
Mailing Address - Country:US
Mailing Address - Phone:253-260-6521
Mailing Address - Fax:
Practice Address - Street 1:6704 TACOMA MALL BLVD STE 111
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-9001
Practice Address - Country:US
Practice Address - Phone:253-260-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602855581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical