Provider Demographics
NPI:1477718831
Name:GAMBLE-MITCHELL, JOCELYN R (LPCC)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:R
Last Name:GAMBLE-MITCHELL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:GAMBLE
Other - Last Name:MIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:707 BROADWAY BLVD NE
Mailing Address - Street 2:#300
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2360
Mailing Address - Country:US
Mailing Address - Phone:505-345-8471
Mailing Address - Fax:
Practice Address - Street 1:707 BROADWAY BLVD NE
Practice Address - Street 2:#300
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2360
Practice Address - Country:US
Practice Address - Phone:505-345-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0115321101YM0800X
NM0178451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health