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General NPI Number Information
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NPI Number | 1336807254
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Entity Type | Organization
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Legal Business Name | GALLUP COMMUNITY HEALTH
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 2111 COLLEGE DR
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City | GALLUP
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State | NM
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Zip | 87301-5600
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Country | US
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Telephone | 505-397-5381
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Fax | 877-396-1184
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Provider Business Mailing Address
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Address Line | 2111 COLLEGE DR
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City | GALLUP
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State | NM
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Zip | 87301-5600
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Country | US
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Telephone | 505-397-5381
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. VALORY WANGLER
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Credential | MD
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Telephone | 206-861-5767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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