Healthcare Provider Details

I. General information

NPI: 1780605246
Provider Name (Legal Business Name): GAYLE TRENBERTH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 N SILVER ST
SILVER CITY NM
88061-7025
US

IV. Provider business mailing address

1816 N SILVER ST
SILVER CITY NM
88061-7025
US

V. Phone/Fax

Practice location:
  • Phone: 575-404-0630
  • Fax:
Mailing address:
  • Phone: 575-404-0630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 5584
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-2023-0111
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: