MEDICARE: JESSE GRAJEDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CTB-2026-0256	NM

General Provider Information

NPI Number	:	1265374490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE GRAJEDA

Provider Business Mailing Address
First Line	:	2232 CALAIS AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-5252
Country	:	US
Telephone Number	:	575-636-3680
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 N TELSHOR BLVD STE E
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8279
Country	:	US
Telephone Number	:	575-636-3680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ JESSE GRAJEDA ” Practice Location

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