Healthcare Provider Details

I. General information

NPI: 1326942640
Provider Name (Legal Business Name): NORMA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W BROADWAY AVE STE 2
COLUMBUS NM
88029-9341
US

IV. Provider business mailing address

PO BOX 128
COLUMBUS NM
88029-0128
US

V. Phone/Fax

Practice location:
  • Phone: 575-494-1912
  • Fax: 575-531-2633
Mailing address:
  • Phone: 575-494-1912
  • Fax: 575-531-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: