Provider Demographics
NPI:1427325307
Name:AYOUB, JOSEPH S (LCSW, LCDC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:S
Last Name:AYOUB
Suffix:
Gender:M
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 WESTMORELAND DR STE 215
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5623
Mailing Address - Country:US
Mailing Address - Phone:915-201-0702
Mailing Address - Fax:
Practice Address - Street 1:1155 WESTMORELAND DR STE 215
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5623
Practice Address - Country:US
Practice Address - Phone:915-201-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-090311041C0700X
TX609081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74481Medicaid