Healthcare Provider Details

I. General information

NPI: 1043601313
Provider Name (Legal Business Name): GALLUP CHILD AND FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W MESA AVE
GALLUP NM
87301-6335
US

IV. Provider business mailing address

213 W MESA AVE
GALLUP NM
87301-6335
US

V. Phone/Fax

Practice location:
  • Phone: 505-862-9776
  • Fax:
Mailing address:
  • Phone: 505-862-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH A. TERRILL
Title or Position: OWNER AND MENTAL HEALTH COUNSELOR
Credential: LPCC
Phone: 505-862-9776