Healthcare Provider Details

I. General information

NPI: 1285770198
Provider Name (Legal Business Name): GRAMBLING THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4686 CORRALES RD
CORRALES NM
87048-8610
US

IV. Provider business mailing address

4686 CORRALES RD
CORRALES NM
87048-8610
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-7693
  • Fax: 505-890-4223
Mailing address:
  • Phone: 505-266-7693
  • Fax: 505-890-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0642
License Number StateNM

VIII. Authorized Official

Name: GAIL GRAMBLING HARRISON
Title or Position: PRESIDENT
Credential:
Phone: 505-266-7693