Provider Demographics
NPI:1780605246
Name:TRENBERTH, GAYLE (PHD)
Entity type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:
Last Name:TRENBERTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 N SILVER ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7025
Mailing Address - Country:US
Mailing Address - Phone:575-404-0630
Mailing Address - Fax:
Practice Address - Street 1:1816 N SILVER ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7025
Practice Address - Country:US
Practice Address - Phone:575-404-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5584103TC0700X
NMPSY-2023-0111103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330627184OtherBLUE CROSS
NM37208870Medicaid