Healthcare Provider Details

I. General information

NPI: 1689988982
Provider Name (Legal Business Name): CLAUDIA WILSEY-GOPP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CLAUDIA B WILSEY-GOPP

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LA POSTA RD
TAOS NM
87571-7240
US

IV. Provider business mailing address

PO BOX 3132
TAOS NM
87571-3132
US

V. Phone/Fax

Practice location:
  • Phone: 575-224-6702
  • Fax: 505-633-7620
Mailing address:
  • Phone: 575-779-6563
  • Fax: 505-633-7620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10566
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: