Healthcare Provider Details

I. General information

NPI: 1467150805
Provider Name (Legal Business Name): VALERIE S AREVALO LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 HAINES AVE NW
ALBUQUERQUE NM
87102-1226
US

IV. Provider business mailing address

1401 PENNSYLVANIA ST NE APT 1162
ALBUQUERQUE NM
87110-7534
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-5611
  • Fax:
Mailing address:
  • Phone: 505-328-6195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2023-0088
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: