Healthcare Provider Details

I. General information

NPI: 1063230530
Provider Name (Legal Business Name): BRITNEY MARIE GILBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 OFFICE COURT DRIVER STE 102
SANTA FE NM
87507
US

IV. Provider business mailing address

4001 OFFICE COURT DRIVER STE 102
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 505-395-9437
  • Fax:
Mailing address:
  • Phone: 505-395-9437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB20240667
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: