Healthcare Provider Details

I. General information

NPI: 1275364549
Provider Name (Legal Business Name): JOSIAH GUCK LMSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 LITTLE WALNUT RD
SILVER CITY NM
88061-6202
US

IV. Provider business mailing address

1218 N LOUISIANA ST
SILVER CITY NM
88061-4243
US

V. Phone/Fax

Practice location:
  • Phone: 575-956-2120
  • Fax:
Mailing address:
  • Phone: 575-313-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2024-0600
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: