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General NPI Number Information
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NPI Number | 1861949943
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Entity Type | Organization
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Legal Business Name | GRYPHON COUNSELING LLC
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 229 GRACELAND DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-1114
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Country | US
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Telephone | 575-590-4690
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Fax |
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Provider Business Mailing Address
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Address Line | 4312 CARLISLE BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-4811
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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 | OWNER
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Name | JAY GLICKMAN
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Credential | LPCC
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Telephone | 575-590-4690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0125451
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License Number State | NM
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