Provider Demographics
NPI:1437791415
Name:TAFOYA-TORREZ, GABRIELLA MARIA (LPCC)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:MARIA
Last Name:TAFOYA-TORREZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4273 MONTGOMERY BLVD NE STE K220
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6748
Mailing Address - Country:US
Mailing Address - Phone:505-554-1283
Mailing Address - Fax:
Practice Address - Street 1:4253 MONTGOMERY BLVD NE STE G130
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1106
Practice Address - Country:US
Practice Address - Phone:505-554-1283
Practice Address - Fax:505-207-6167
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0225441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46157212Medicaid