MEDICARE: HEATHER L GARDENHIRE BA, LMT

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	225700000X	Massage Therapist	MT8310	NM
2	101YM0800X	Mental Health Counselor		NM

General Provider Information

NPI Number	:	1316573884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER L GARDENHIRE BA, LMT

Provider Business Mailing Address
First Line	:	724 W ANIMAS ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5617
Country	:	US
Telephone Number	:	505-793-1760
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 W ANIMAS ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5617
Country	:	US
Telephone Number	:	505-793-1760
Fax Number	:

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

Provider Enumeration Date	:	03/17/2020
Last Update Date	:	05/28/2026

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