Provider Demographics
NPI:1801220975
Name:GALE, REBECCA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:GALE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 HIGHWAY 140
Mailing Address - Street 2:
Mailing Address - City:HESPERUS
Mailing Address - State:CO
Mailing Address - Zip Code:81326-9354
Mailing Address - Country:US
Mailing Address - Phone:303-521-5598
Mailing Address - Fax:
Practice Address - Street 1:1615 OJO COURT
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:84701
Practice Address - Country:US
Practice Address - Phone:505-564-4804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1899101YM0800X
NMX-103501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1740659804OtherPMS DBA TOTAH BEHAVIORAL HEALTH