Organization
GALLUP OUTPATIENT TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERA JOHN LPCC (BEHAVIORAL HEALTH DIRECTOR)
(505) 722-9470
Entity
Organization
Contact information
Practice address
300 WEST NIZHONI BLVD., SUITE A, GALLUP, NM 87301
(505) 722-9470
(505) 722-9570
Mailing address
300 WEST NIZHONI BLVD., SUITE A, GALLUP, NM 87301
(505) 722-9470
(505) 722-9570
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0131901
NM
Other
Enumeration date
06/04/2012
Last updated
03/10/2022
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