Provider Demographics
NPI:1659748317
Name:GERALD GARNER MA LPC
Entity Type:Organization
Organization Name:GERALD GARNER MA LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:505-270-3517
Mailing Address - Street 1:1737 VISTA DE COLINAS DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4158
Mailing Address - Country:US
Mailing Address - Phone:505-270-3517
Mailing Address - Fax:
Practice Address - Street 1:1737 VISTA DE COLINAS DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4158
Practice Address - Country:US
Practice Address - Phone:505-270-3517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1517251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health