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General NPI Number Information
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NPI Number | 1316982705
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Entity Type | Individual
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Provider Name | DR. TREVOR G GATES-CRANDALL
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 8531 INDIAN SCHOOL RD NE PMB 1020
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City | ALBUQUERQUE
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State | NM
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Zip | 87112
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Country | US
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Telephone | 505-445-5279
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Fax |
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Provider Business Mailing Address
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Address Line | 8531 INDIAN SCHOOL RD NE PMB 1020
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City | ALBUQUERQUE
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State | NM
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Zip | 87112
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW04740
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CTB-2024-0474
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C11795
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License Number State | NM
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