Healthcare Provider Details

I. General information

NPI: 1154296366
Provider Name (Legal Business Name): MARIANNE GAMBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 OFFICE COURT DR # 602
SANTA FE NM
87507-4929
US

IV. Provider business mailing address

3201 ZAFARANO DR STE C
SANTA FE NM
87507-2672
US

V. Phone/Fax

Practice location:
  • Phone: 505-207-8929
  • Fax: 505-365-2902
Mailing address:
  • Phone: 505-207-8929
  • Fax: 505-365-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB20250932
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: