Healthcare Provider Details

I. General information

NPI: 1447133780
Provider Name (Legal Business Name): THELMA YVONNE GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LOUISIANA BLVD NE
ALBUQUERQUE NM
87110-4303
US

IV. Provider business mailing address

2116 GLENWOOD DR
ABILENE TX
79605-5704
US

V. Phone/Fax

Practice location:
  • Phone: 505-295-3110
  • Fax:
Mailing address:
  • Phone: 325-829-7843
  • Fax: 325-829-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0488
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: