Individual
AUDRA GENDUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1800 OLD PECOS TRL STE B, SANTA FE, NM 87505-4787
(505) 690-6679
Mailing address
8 GRAYHAWK PL, SANTA FE, NM 87508-1332
(505) 690-6679
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CMH0216981
NM
171W00000X
Contractor
4830
NM
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
11/18/2013
Last updated
03/16/2022
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