Healthcare Provider Details

I. General information

NPI: 1982762100
Provider Name (Legal Business Name): DEBRA SUE GALLANT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CARLISLE NE SUITE 108
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

PO BOX 35505
ALBUQUERQUE NM
87176
US

V. Phone/Fax

Practice location:
  • Phone: 505-889-4581
  • Fax: 505-889-4598
Mailing address:
  • Phone: 505-889-4581
  • Fax: 505-889-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCC0882
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: