Individual
KEHALA GLEASON TWO BULLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LMHC
Contact information
Practice address
612 N PASEO DE ONATE, ESPANOLA, NM 87532-2963
(505) 753-2203
Mailing address
612 N PASEO DE ONATE, ESPANOLA, NM 87532-2963
(505) 753-2203
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
T-0144261
NM
Other
Enumeration date
10/31/2008
Last updated
12/12/2011
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