Healthcare Provider Details

I. General information

NPI: 1447137856
Provider Name (Legal Business Name): RAE CEE VALLEJOS MD, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 W DELGADO AVE
BELEN NM
87002-2805
US

IV. Provider business mailing address

1611 W DELGADO AVE
BELEN NM
87002-2805
US

V. Phone/Fax

Practice location:
  • Phone: 505-966-1304
  • Fax:
Mailing address:
  • Phone: 505-720-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-20250581
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0581
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: