Healthcare Provider Details

I. General information

NPI: 1285795039
Provider Name (Legal Business Name): ANGELA RENEE GAUTIER MS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 LEROY PL
SOCORRO NM
87801-4680
US

IV. Provider business mailing address

801 LEROY PL
SOCORRO NM
87801-4680
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-6619
  • Fax: 575-835-6001
Mailing address:
  • Phone: 575-835-6619
  • Fax: 575-835-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0201341
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: