Healthcare Provider Details

I. General information

NPI: 1770274623
Provider Name (Legal Business Name): GABRIELLE ANZURES LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 EDITH DR
BELEN NM
87002-2807
US

IV. Provider business mailing address

4101 CORRALES RD UNIT 8
CORRALES NM
87048-4000
US

V. Phone/Fax

Practice location:
  • Phone: 505-588-8563
  • Fax:
Mailing address:
  • Phone: 505-588-8563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: