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NPI Code Detail

MEDICARE: KYLEE J GORDLEY-SHURTER LPCC

MEDICARE: KYLEE J GORDLEY-SHURTER 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
1101YP2500XProfessional CounselorNM005691NM
2101YM0800XMental Health CounselorNM00561NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871591834
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLEE J GORDLEY-SHURTER LPCC
Provider Business Mailing Address
First Line : PO BOX 2997
Second Line :
City : CORRALES
State : NM
Zip : 87048-2997
Country : US
Telephone Number : 505-891-9581
Fax Number : 505-867-5924
Provider Business Practice Location Address
First Line : 4686 CORRALES RD
Second Line :
City : CORRALES
State : NM
Zip : 87048-8610
Country : US
Telephone Number : 505-891-9581
Fax Number : 505-867-5924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 04/08/2008

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