Provider Demographics
NPI:1457627614
Name:JOPHIEL, IAM (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IAM
Middle Name:
Last Name:JOPHIEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NAHNAHSHA
Other - Middle Name:
Other - Last Name:DEAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 50053
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87181-0053
Mailing Address - Country:US
Mailing Address - Phone:314-800-0311
Mailing Address - Fax:314-228-0367
Practice Address - Street 1:8045 BIG BEND BLVD, STE 101
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2714
Practice Address - Country:US
Practice Address - Phone:314-800-0311
Practice Address - Fax:314-228-0367
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099272271041C0700X
NMC-098541041C0700X
MO20110351801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical