Healthcare Provider Details

I. General information

NPI: 1750179032
Provider Name (Legal Business Name): JOSELYN C GLICCO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7027 MONTGOMERY BLVD NE STE F
ALBUQUERQUE NM
87109-1529
US

IV. Provider business mailing address

2713 QUINCY ST NE
ALBUQUERQUE NM
87110-3053
US

V. Phone/Fax

Practice location:
  • Phone: 505-880-0100
  • Fax:
Mailing address:
  • Phone: 505-379-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number352776
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2023-0221
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: