1538449814 NPI number — MRS. JOELLYN PAULINE MAGOOSH BA PSYCHOLOGY, LSAA

Table of content: MRS. JOELLYN PAULINE MAGOOSH BA PSYCHOLOGY, LSAA (NPI 1538449814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538449814 NPI number — MRS. JOELLYN PAULINE MAGOOSH BA PSYCHOLOGY, LSAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGOOSH
Provider First Name:
JOELLYN
Provider Middle Name:
PAULINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BA PSYCHOLOGY, LSAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538449814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 CUBA AVE
Provider Second Line Business Mailing Address:
P.O. BOX 114
Provider Business Mailing Address City Name:
ALAMOGORDO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88310-5727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-437-2453
Provider Business Mailing Address Fax Number:
575-443-1504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 CUBA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88310-5727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-437-2453
Provider Business Practice Location Address Fax Number:
575-443-1504
Provider Enumeration Date:
08/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  0141431 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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