Healthcare Provider Details

I. General information

NPI: 1225048309
Provider Name (Legal Business Name): GAIL L HAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001-D BROADWAY
FARMINGTON NM
97401
US

IV. Provider business mailing address

PO BOX 131
AZTEC NM
87410-0131
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-0238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1215
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-1833
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: