Provider Demographics
NPI:1336372614
Name:ROBERTSON, GAIL ANN (MA, CPRP, LMHC)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MA, CPRP, LMHC
Other - Prefix:MISS
Other - First Name:GAIL
Other - Middle Name:ANN
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 EL CENTRO FAMILIAR BLVD SW BLDG B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 EL CENTRO FAMILIAR BLVD SW BLDG B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4592
Practice Address - Country:US
Practice Address - Phone:505-272-5654
Practice Address - Fax:505-873-5970
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NM0149581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health