Provider Demographics
NPI:1689988982
Name:WILSEY-GOPP, CLAUDIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:
Last Name:WILSEY-GOPP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CLAUDIA
Other - Middle Name:B
Other - Last Name:WILSEY-GOPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3132
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-3132
Mailing Address - Country:US
Mailing Address - Phone:575-779-6563
Mailing Address - Fax:505-633-7620
Practice Address - Street 1:125 LA POSTA RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-7240
Practice Address - Country:US
Practice Address - Phone:575-224-6702
Practice Address - Fax:505-633-7620
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-105661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty