Healthcare Provider Details

I. General information

NPI: 1316573884
Provider Name (Legal Business Name): HEATHER L GARDENHIRE LMHC, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 W ANIMAS ST
FARMINGTON NM
87401-5617
US

IV. Provider business mailing address

724 W ANIMAS ST
FARMINGTON NM
87401-5617
US

V. Phone/Fax

Practice location:
  • Phone: 505-793-1760
  • Fax:
Mailing address:
  • Phone: 505-793-1760
  • Fax: 888-263-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0565
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT8310
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: