Provider Demographics
NPI:1245483460
Name:TWO BULLS, KEHALA GLEASON (MA LMHC)
Entity type:Individual
Prefix:
First Name:KEHALA
Middle Name:GLEASON
Last Name:TWO BULLS
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:KEHALA
Other - Middle Name:TATEWIN
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:612 N PASEO DE ONATE
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2963
Mailing Address - Country:US
Mailing Address - Phone:505-753-2203
Mailing Address - Fax:
Practice Address - Street 1:612 N PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2963
Practice Address - Country:US
Practice Address - Phone:505-753-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0144261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health