Healthcare Provider Details

I. General information

NPI: 1972854123
Provider Name (Legal Business Name): JULIANA MARIE STRAVERS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 02/08/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 HASLER VALLEY RD
GALLUP NM
87305
US

IV. Provider business mailing address

303 S FIRST ST
GALLUP NM
87301-6211
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-4985
  • Fax:
Mailing address:
  • Phone: 505-397-7197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013098
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0187131
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: