Provider Demographics
NPI:1639249691
Name:GURLEY, VERJEANA F (RNCS, LPCC)
Entity Type:Individual
Prefix:MS
First Name:VERJEANA
Middle Name:F
Last Name:GURLEY
Suffix:
Gender:F
Credentials:RNCS, LPCC
Other - Prefix:MS
Other - First Name:JEANA
Other - Middle Name:F
Other - Last Name:GURLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNCS, LPCC
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:
Practice Address - Street 1:8300 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7613
Practice Address - Country:US
Practice Address - Phone:505-291-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC 2100101YP2500X
NMR24893364SP0809X
NMCCMH2100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2037086OtherCIGNA BEHAVIORAL HEALTH
NM10001433OtherLOVELACE HEALTH PLAN
NMNM000113OtherVALUE OPTIONS
NMP00915Medicare UPIN