Healthcare Provider Details

I. General information

NPI: 1871827899
Provider Name (Legal Business Name): DELCIA MAURICE GUDGEL LPCC NM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SUDDERTH DRIVE LA FRONTERA
RUIDOSO NM
88345
US

IV. Provider business mailing address

1320 S. SOLANO
LAS CRUCES NM
88001
US

V. Phone/Fax

Practice location:
  • Phone: 575-630-0571
  • Fax: 575-630-0574
Mailing address:
  • Phone: 575-527-7900
  • Fax: 575-571-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2493
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: