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NPI Code Detail

MEDICARE: MS. GAIL J GRAMBLING HARRISON LPCC

MEDICARE: MS. GAIL J GRAMBLING HARRISON LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor0642NM

General Provider Information

NPI Number : 1588686448
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GAIL J GRAMBLING HARRISON LPCC
Provider Business Mailing Address
First Line : PO BOX 1069
Second Line :
City : CORRALES
State : NM
Zip : 87048-1069
Country : US
Telephone Number : 505-266-7693
Fax Number : 505-890-4223
Provider Business Practice Location Address
First Line : 4686 CORRALES RD
Second Line :
City : CORRALES
State : NM
Zip : 87048-8610
Country : US
Telephone Number : 505-266-7693
Fax Number : 505-890-4223
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2006
Last Update Date : 07/08/2007

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