Individual
GLYNNIS PELLETT URBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CMHC
Contact information
Practice address
1118 W AZTEC BLVD, AZTEC, NM 87410-1800
(505) 334-3695
(505) 599-4388
Mailing address
1118 W AZTEC BLVD, AZTEC, NM 87410-1800
(505) 419-9926
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2292
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23930772
—
NM
Enumeration date
11/07/2006
Last updated
03/19/2024
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