MEDICARE: DR. GAYLE TRENBERTH PH.D.

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
1	103TC0700X	Clinical Psychologist	PSY 5584	CA
2	103T00000X	Psychologist	PSY-2023-0111	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	330627184	OTHER	CA	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780605246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYLE TRENBERTH PH.D.

Provider Business Mailing Address
First Line	:	1816 N SILVER ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7025
Country	:	US
Telephone Number	:	575-404-0630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 N SILVER ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7025
Country	:	US
Telephone Number	:	575-404-0630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/13/2024

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