Active NPI
Amanda Elizabeth Tanner, LPCC, NCC
- Professional Counselor
- Gallup, NM
National Provider Identifier
1306604863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- CTB-2025-0696
- Practice address
- 47 Mt. Mahogany
Gallup, NM 87301 - Phone
- (505) 879-9938
- NPI assigned
- Mar 11, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CTB-2025-0696 | NM | Primary |
Addresses
Primary practice location
47 Mt. Mahogany
Gallup, NM 87301
Mailing address
PO Box 4837
Gallup, NM 87305-4837
Phone (505) 879-9938
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CTB-2025-0696 | NM | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772755200000",
"number": "1306604863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4837",
"city": "GALLUP",
"state": "NM",
"postal_code": "873054837",
"telephone_number": "505-879-9938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "47 MT. MAHOGANY",
"city": "GALLUP",
"state": "NM",
"postal_code": "87301",
"telephone_number": "505-879-9938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANNER",
"first_name": "AMANDA",
"middle_name": "ELIZABETH",
"credential": "LPCC, NCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-11",
"last_updated": "2026-03-06",
"certification_date": "2026-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NM",
"license": "CTB-2025-0696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.