Healthcare Provider Details

I. General information

NPI: 1740841022
Provider Name (Legal Business Name): VALERIE MAESTAS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S 2ND ST
RATON NM
87740-2102
US

IV. Provider business mailing address

PO BOX 8
RATON NM
87740-0008
US

V. Phone/Fax

Practice location:
  • Phone: 505-398-1567
  • Fax: 575-383-3337
Mailing address:
  • Phone: 505-382-4922
  • Fax: 575-383-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-CTL0204921
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: