Healthcare Provider Details

I. General information

NPI: 1316982705
Provider Name (Legal Business Name): DR. TREVOR G GATES-CRANDALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TREVOR G GATES PHD, LCSW

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8531 INDIAN SCHOOL RD NE PMB 1020
ALBUQUERQUE NM
87112
US

IV. Provider business mailing address

8531 INDIAN SCHOOL RD NE PMB 1020
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 505-445-5279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04740
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2024-0474
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC11795
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: