Healthcare Provider Details

I. General information

NPI: 1760787899
Provider Name (Legal Business Name): CHRISTINE GLOVER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 RODEO PARK DRIVE WEST SANTA FE COMMUNITY GUIDANCE CENTER
SANTA FE NM
87505-6351
US

IV. Provider business mailing address

495 CAMINO DON MIGUEL
SANTA FE NM
87505-5947
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-9633
  • Fax:
Mailing address:
  • Phone: 505-820-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0137201
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: