Individual
MR. GARY D LONGANECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
110 WALNUT STREET, OFFICE B, CLAYTON, NM 88415
(505) 374-2032
(505) 374-0158
Mailing address
509 MAIN ST, CLAYTON, NM 88415-2921
(505) 374-9830
(505) 374-0158
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1573
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95071881
—
NM
Enumeration date
05/17/2006
Last updated
07/08/2007
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