Individual
MS. ANGELA RENEE GAUTIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LPCC
Contact information
Practice address
801 LEROY PL, SOCORRO, NM 87801-4680
(575) 835-6619
(575) 835-6001
Mailing address
801 LEROY PL, SOCORRO, NM 87801-4680
(575) 835-6619
(575) 835-6001
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6152
MA
101YP2500X
Professional Counselor
Primary
CCMH0201341
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042611055
TAX ID
MA
01
—
1303287
MBHP
MA
05
—
1303287
—
MA
05
—
703136
—
MA
01
—
M18633
BC BC
MA
01
—
NP01332
BMC
MA
Enumeration date
12/13/2006
Last updated
01/13/2026
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