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NPI Code Detail

MEDICARE: GARY LEE WHITE LPCC

MEDICARE: GARY LEE WHITE LPCC
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
1101YP2500XProfessional Counselor0102561NM

General Provider Information

NPI Number : 1215141676
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY LEE WHITE LPCC
Provider Business Mailing Address
First Line : 725-5 TRAMWAY VISTA LOOP NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87122-1669
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 725-5 TRAMWAY VISTA LOOP NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87122-1669
Country : US
Telephone Number : 505-507-3882
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 06/09/2026

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