MEDICARE: VAILLANCOURT ASSOCIATES LLC DBA ALAMEDA MARRIAGE AND FAMILY THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0109041	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063859015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAILLANCOURT ASSOCIATES LLC DBA ALAMEDA MARRIAGE AND FAMILY THERAPY

Provider Business Mailing Address
First Line	:	619 N ALAMEDA BLVD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2130
Country	:	US
Telephone Number	:	575-405-7146
Fax Number	:	575-405-5446

Provider Business Practice Location Address
First Line	:	304 W GRIGGS AVE STE C
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2603
Country	:	US
Telephone Number	:	575-405-7146
Fax Number	:	575-405-5446

Authorized Official
Title or Position	:	CEO
Name	:	DR. KOURTNEY T. VAILLANCOURT
Credential	:	LMFT, LADAC, CFLE
Telephone Number	:	575-405-7146

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	10/09/2025

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