Provider Demographics
NPI:1306296116
Name:KANAWITE, GABRIEL JOSEPH SR
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:JOSEPH
Last Name:KANAWITE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GABRIEL
Other - Middle Name:JOSEPH
Other - Last Name:KANAWITE
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:LSAA
Mailing Address - Street 1:PO BOX 3809
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-3809
Mailing Address - Country:US
Mailing Address - Phone:505-870-1483
Mailing Address - Fax:505-870-1483
Practice Address - Street 1:216 W MALONEY AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5214
Practice Address - Country:US
Practice Address - Phone:505-870-1483
Practice Address - Fax:505-870-1483
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0065872101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor