=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447133780
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THELMA YVONNE GRAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2025
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 LOUISIANA BLVD NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87110-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-295-3110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2116 GLENWOOD DR
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79605-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-829-7843
-----------------------------------------------------
Fax | 325-829-7843
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CTB-2025-0488
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------