Healthcare Provider Details

I. General information

NPI: 1063986743
Provider Name (Legal Business Name): GABRIELA MILLER LMFT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 4TH ST NW STE E-2
LOS RANCHOS NM
87107-5800
US

IV. Provider business mailing address

2317 BRITT ST NE
ALBUQUERQUE NM
87112-1541
US

V. Phone/Fax

Practice location:
  • Phone: 505-803-1923
  • Fax:
Mailing address:
  • Phone: 505-803-1923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: APRIL BANCROFT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 505-384-7352