Provider Demographics
NPI:1265797195
Name:COEQUYT, GLORIA MARIE (MA,, LPCC)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:MARIE
Last Name:COEQUYT
Suffix:
Gender:F
Credentials:MA,, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N GUADALUPE ST # 563
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1868
Mailing Address - Country:US
Mailing Address - Phone:505-577-5887
Mailing Address - Fax:
Practice Address - Street 1:208 GRANT AVE STE 309
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1932
Practice Address - Country:US
Practice Address - Phone:505-577-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional