Healthcare Provider Details

I. General information

NPI: 1639249691
Provider Name (Legal Business Name): VERJEANA F. GURLEY RNCS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEANA F. GURLEY RNCS, LPCC

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

PO BOX 26666 PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2134
  • Fax:
Mailing address:
  • Phone: 505-923-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC 2100
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR24893
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH2100
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: