Healthcare Provider Details

I. General information

NPI: 1023696705
Provider Name (Legal Business Name): JOSHUA GAMEZ LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 ZUNI RD SE
ALBUQUERQUE NM
87108-3073
US

IV. Provider business mailing address

5901 ZUNI RD SE
ALBUQUERQUE NM
87108-3073
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-6380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2022-0818
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: