Kitchen Table Counseling Professional LLC
Social Worker, Clinical in Gallup, NM. Organization (NPI-2).
NPI number1861098857
StatusActive
Last updated in NPPESDec 7, 2020
Details
- NPI
- 1861098857
- Entity type
- Organization (NPI-2)
- Legal business name
- Kitchen Table Counseling Professional LLC
- Organization subpart
- No
- Enumeration date
- Dec 7, 2020
- Certification date
- Dec 7, 2020
- Last updated
- Dec 7, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | – | – | Yes |
| 251B00000X | Case Management | – | – | |
| 251S00000X | Community/Behavioral Health | – | – | |
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – |
Practice location
333 E Jefferson StGallup, NM 87301-5113
Phone 360-433-7755
Mailing address
333 E Jefferson StGallup, NM 87301-5113
Phone 360-433-7755
Authorized official
Sandra Geary
Member
3604337755
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