Provider Demographics
NPI:1750179032
Name:GLICCO, JOSELYN C (LMHC)
Entity type:Individual
Prefix:MS
First Name:JOSELYN
Middle Name:C
Last Name:GLICCO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 QUINCY ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3053
Mailing Address - Country:US
Mailing Address - Phone:505-379-6111
Mailing Address - Fax:
Practice Address - Street 1:7027 MONTGOMERY BLVD NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1529
Practice Address - Country:US
Practice Address - Phone:505-880-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM352776101YS0200X
NMCTB-2023-0221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool