Healthcare Provider Details

I. General information

NPI: 1497695613
Provider Name (Legal Business Name): GINA MCFAUL LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N. PERSHING
TRUTH OR CONSEQUENCES NM
87901
US

IV. Provider business mailing address

1802 PERSHING
TRUTH OR CONSEQUENCES NM
87901
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-8380
  • Fax:
Mailing address:
  • Phone: 575-894-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberB-3424
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: