Provider Demographics
NPI:1184096190
Name:GIRON, GARY LEE JOSEPH
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE JOSEPH
Last Name:GIRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 TECAMEC RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-3297
Mailing Address - Country:US
Mailing Address - Phone:505-410-5648
Mailing Address - Fax:
Practice Address - Street 1:5310 HOMESTEAD RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1437
Practice Address - Country:US
Practice Address - Phone:505-503-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0092241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional