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General NPI Number Information
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NPI Number | 1265797195
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Entity Type | Individual
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Provider Name | GLORIA MARIE COEQUYT M.A.,, L.P.C.C.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 208 GRANT AVE STE 309
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City | SANTA FE
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State | NM
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Zip | 87501-1932
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Country | US
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Telephone | 505-577-5887
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Fax |
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Provider Business Mailing Address
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Address Line | 223 N GUADALUPE ST # 563
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City | SANTA FE
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State | NM
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Zip | 87501-1868
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Country | US
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Telephone | 505-577-5887
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0636
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License Number State | NM
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