Healthcare Provider Details

I. General information

NPI: 1649463209
Provider Name (Legal Business Name): KRISTINA MARIE VALDIVIEZO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 BRANSON AVE APT 8B
LAS CRUCES NM
88001-0505
US

IV. Provider business mailing address

1345 BRANSON AVE APT 8B
LAS CRUCES NM
88001-0505
US

V. Phone/Fax

Practice location:
  • Phone: 575-937-9494
  • Fax:
Mailing address:
  • Phone: 575-937-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0136941
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: