Provider Demographics
NPI:1245336973
Name:VIETHEN, GABRIELLE M (LMFT)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:M
Last Name:VIETHEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ALTURA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8329
Mailing Address - Country:US
Mailing Address - Phone:505-988-1431
Mailing Address - Fax:
Practice Address - Street 1:1421 LUISA ST STE Q3
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4073
Practice Address - Country:US
Practice Address - Phone:505-988-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0708106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0708OtherLMFT LICENSE
NM201029710OtherPRESBYTERIAN PROVIDER