MEDICARE: DR. TREVOR RANTG GATES-CRANDALL PHD, LCSW

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	1041C0700X	Clinical Social Worker	CSW.09927211	CO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CTB-2024-0474	NM
3	1041C0700X	Clinical Social Worker	40424	TX
4	1041C0700X	Clinical Social Worker	080344	NY
5	1041C0700X	Clinical Social Worker	ISW04740	RI
6	1041C0700X	Clinical Social Worker	149013034	IL
7	1041C0700X	Clinical Social Worker	4225	NE
8	1041C0700X	Clinical Social Worker	C11795	NM
9	1041C0700X	Clinical Social Worker	089.0136663	VT

General Provider Information

NPI Number	:	1316982705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR RANTG GATES-CRANDALL PHD, LCSW

Provider Business Mailing Address
First Line	:	8531 INDIAN SCHOOL RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-2837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8531 INDIAN SCHOOL RD NE PMB 1020
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112
Country	:	US
Telephone Number	:	505-445-5279
Fax Number	:

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	04/09/2026

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