Provider Demographics
NPI:1629361571
Name:HODGES, GARY S (LMHC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:S
Last Name:HODGES
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7850 JEFFERSON ST NE STE 300
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4314
Mailing Address - Country:US
Mailing Address - Phone:505-884-1114
Mailing Address - Fax:505-856-6320
Practice Address - Street 1:7850 JEFFERSON ST NE
Practice Address - Street 2:SUITE 300
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4315
Practice Address - Country:US
Practice Address - Phone:505-884-1114
Practice Address - Fax:505-856-6320
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM140151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM6953904Medicaid