Healthcare Provider Details

I. General information

NPI: 1083954937
Provider Name (Legal Business Name): TESS AMY GAUDET LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9007 WASHINGTON ST NE
ALBUQUERQUE NM
87113-2722
US

IV. Provider business mailing address

9007 WASHINGTON ST NE
ALBUQUERQUE NM
87113-2722
US

V. Phone/Fax

Practice location:
  • Phone: 505-209-3417
  • Fax: 505-444-6513
Mailing address:
  • Phone: 505-209-3417
  • Fax: 505-444-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0196861
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: