Basic Information
| Provider Information | |||||||||
| NPI: | 1518485408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMEZ | ||||||||
| FirstName: | JOY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94508 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871994508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053847352 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1990 E LOHMAN AVE # 218 | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880013172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756394930 | ||||||||
| FaxNumber: | 5752336275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2017 | ||||||||
| LastUpdateDate: | 08/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | T-0189741 | NM | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.