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General NPI Number Information
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NPI Number | 1538449814
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Entity Type | Individual
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Provider Name | JOELLYN PAULINE MAGOOSH BA PSYCHOLOGY, LSAA
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Gender | Female
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 1301 CUBA AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310-5727
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Country | US
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Telephone | 575-437-2453
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Fax | 575-443-1504
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Provider Business Mailing Address
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Address Line | 1301 CUBA AVE P.O. BOX 114
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City | ALAMOGORDO
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State | NM
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Zip | 88310-5727
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Country | US
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Telephone | 575-437-2453
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Fax | 575-443-1504
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0141431
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License Number State | NM
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