Healthcare Provider Details

I. General information

NPI: 1972450773
Provider Name (Legal Business Name): GUYLA J MAPLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N MISSOURI AVE
ROSWELL NM
88201-4747
US

IV. Provider business mailing address

508 N MISSOURI AVE
ROSWELL NM
88201-4747
US

V. Phone/Fax

Practice location:
  • Phone: 575-910-6555
  • Fax:
Mailing address:
  • Phone: 575-910-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number224187
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: