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General NPI Number Information
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NPI Number | 1750179032
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Entity Type | Individual
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Provider Name | JOSELYN C GLICCO LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 7027 MONTGOMERY BLVD NE STE F
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1529
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Country | US
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Telephone | 505-880-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 2713 QUINCY ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3053
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Country | US
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Telephone | 505-379-6111
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Fax |
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 352776
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CTB-2023-0221
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License Number State | NM
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