Healthcare Provider Details

I. General information

NPI: 1871591834
Provider Name (Legal Business Name): KYLEE J GORDLEY-SHURTER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYLEE J SHURTER LPCC

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4686 CORRALES RD
CORRALES NM
87048-8610
US

IV. Provider business mailing address

PO BOX 2997
CORRALES NM
87048-2997
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-9581
  • Fax: 505-867-5924
Mailing address:
  • Phone: 505-891-9581
  • Fax: 505-867-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberNM005691
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNM00561
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: