Healthcare Provider Details

I. General information

NPI: 1427346790
Provider Name (Legal Business Name): GERALDINE J GLOVER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 OLD PECOS TRL SUITE C
SANTA FE NM
87505-4779
US

IV. Provider business mailing address

2331 CALLE LUMINOSO
SANTA FE NM
87505-5609
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-7840
  • Fax:
Mailing address:
  • Phone: 505-424-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3262
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: