Provider Demographics
NPI:1740341874
Name:GARLAND, GARY (LADAC,CS & CFAE)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:GARLAND
Suffix:
Gender:M
Credentials:LADAC,CS & CFAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 SUDDERTH DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6201
Mailing Address - Country:US
Mailing Address - Phone:505-257-8942
Mailing Address - Fax:505-257-8943
Practice Address - Street 1:613 SUDDERTH DR
Practice Address - Street 2:SUITE F
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6201
Practice Address - Country:US
Practice Address - Phone:505-257-8942
Practice Address - Fax:505-257-8943
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM #006181101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)