Healthcare Provider Details

I. General information

NPI: 1528602463
Provider Name (Legal Business Name): JULI VALLIERE LADAC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S 3RD ST
RATON NM
87740-4005
US

IV. Provider business mailing address

PO BOX 94508
ALBUQUERQUE NM
87199-4508
US

V. Phone/Fax

Practice location:
  • Phone: 575-733-0003
  • Fax:
Mailing address:
  • Phone: 575-733-0003
  • Fax: 575-733-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAD0201481
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: