Healthcare Provider Details

I. General information

NPI: 1619298585
Provider Name (Legal Business Name): MARIA DEL ROSARIO JOSEFINA GALLARDO NEYRA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 QUANTUM RD NE
RIO RANCHO NM
87124-4502
US

IV. Provider business mailing address

2551 COORS BLVD NW
ALBUQUERQUE NM
87120-1213
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-9178
  • Fax:
Mailing address:
  • Phone: 505-338-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0128851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: