Doctor Name: | GILBERT HERRERA |
NPI Number: | 1114250867 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LSAA |
License Number: | 63541 |
Business Practice Address: | 1350 Paseo Del Pueblo Sur Taos, NM - 875715962 |
Business Phone Number: | 5757375533 |
Business Fax Number: | 5757375534 |
Mailing Address: | Po Box 310, EMBUDO |
State: | NM |
Postal Code: | 875310310 |
Phone Number: | 5055794253 |
Fax Number: | 5055794016 |
NPI Enumeration Date: | 09/14/2009 |
NPI Last Update Date: | 09/14/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 63541 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |