Provider Demographics
NPI:1902148661
Name:GUEVARA, JOLIE A (LBSW)
Entity type:Individual
Prefix:
First Name:JOLIE
Middle Name:A
Last Name:GUEVARA
Suffix:
Gender:
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W AVENUE K
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-5514
Mailing Address - Country:US
Mailing Address - Phone:575-739-2260
Mailing Address - Fax:575-397-4659
Practice Address - Street 1:920 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-5529
Practice Address - Country:US
Practice Address - Phone:575-393-3168
Practice Address - Fax:575-397-4659
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NMSWB-2024-02991041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator