MEDICARE: MARIANNE GAMBLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CTB20250932	NM

General Provider Information

NPI Number	:	1154296366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE GAMBLE

Provider Business Mailing Address
First Line	:	3201 ZAFARANO DR STE C
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2672
Country	:	US
Telephone Number	:	505-207-8929
Fax Number	:	505-365-2902

Provider Business Practice Location Address
First Line	:	4001 OFFICE COURT DR # 602
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-4929
Country	:	US
Telephone Number	:	505-207-8929
Fax Number	:	505-365-2902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	01/19/2026

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