Healthcare Provider Details

I. General information

NPI: 1326745340
Provider Name (Legal Business Name): GARETH HARROLD LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GRANDE BLVD SE STE B
RIO RANCHO NM
87124-1695
US

IV. Provider business mailing address

2200 GRANDE BLVD SE STE B
RIO RANCHO NM
87124-1695
US

V. Phone/Fax

Practice location:
  • Phone: 505-218-6383
  • Fax: 505-636-6338
Mailing address:
  • Phone: 505-218-6383
  • Fax: 505-636-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCBT20220897
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: