Healthcare Provider Details

I. General information

NPI: 1720806003
Provider Name (Legal Business Name): JOSE EDUARDO GALLEGOS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2671
ANTHONY NM
88021-2671
US

IV. Provider business mailing address

PO BOX 2671
ANTHONY NM
88021-2671
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-5100
  • Fax: 575-882-1151
Mailing address:
  • Phone: 575-882-5100
  • Fax: 575-882-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0676
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: