Individual
SELECE GATHINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2201 W BLANCO BLVD, BLOOMFIELD, NM 87413-6737
(505) 360-9624
Mailing address
2201 W BLANCO BLVD, BLOOMFIELD, NM 87413-6737
(505) 609-8820
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
02/21/2025
Last updated
02/21/2025
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