Healthcare Provider Details

I. General information

NPI: 1215164264
Provider Name (Legal Business Name): JAMES GILSON LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 UPTOWN BLVD NE
ALBUQUERQUE NM
87110-4162
US

IV. Provider business mailing address

184 UNSER BLVD NE
RIO RANCHO NM
87124-4045
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-4020
  • Fax: 505-296-8292
Mailing address:
  • Phone: 505-896-0928
  • Fax: 505-896-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0091791
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: