Healthcare Provider Details

I. General information

NPI: 1194976050
Provider Name (Legal Business Name): JOSIE GIBB LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 GUADALUPE CHURCH ST NW
ALBUQUERQUE NM
87107-3171
US

IV. Provider business mailing address

4411 GUADALUPE CHURCH ST NW
ALBUQUERQUE NM
87107-3171
US

V. Phone/Fax

Practice location:
  • Phone: 505-377-7781
  • Fax: 505-717-2776
Mailing address:
  • Phone: 505-377-7781
  • Fax: 505-717-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0099861
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: