Healthcare Provider Details

I. General information

NPI: 1003420696
Provider Name (Legal Business Name): HEIDI MAE GALL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 MOON ST NE
ALBUQUERQUE NM
87112-3935
US

IV. Provider business mailing address

729 CAMINO SANTA ANA
SANTA FE NM
87505-3683
US

V. Phone/Fax

Practice location:
  • Phone: 505-271-4957
  • Fax: 505-271-4957
Mailing address:
  • Phone: 505-303-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-CTL0212831
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0678
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: