MEDICARE: MRS. JULITA GLORIA PEZZANO LPCC

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	101YP2500X	Professional Counselor	CCMH0100131	NM
2	101YM0800X	Mental Health Counselor	CCMH100131	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3037108	OTHER	NM	UHCADVANTAGEPLANS
2	000413612	OTHER	NM	OPTUMBEHAVIORALHEALTH
3	11790874	OTHER	NM	CAQH
4	600670199	OTHER	NM	MAGELLANHEALTHCARE
5	00NM00JBG7	OTHER	NM	BCBSNETWORK
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720292782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULITA GLORIA PEZZANO LPCC

Provider Business Mailing Address
First Line	:	8625 GOLF COURSE RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5114
Country	:	US
Telephone Number	:	505-450-5500
Fax Number	:	889-896-8728

Provider Business Practice Location Address
First Line	:	8625 GOLF COURSE RD NW STE B2
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5114
Country	:	US
Telephone Number	:	505-508-0808
Fax Number	:	888-896-8728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	12/09/2025

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Directions to “ MRS. JULITA GLORIA PEZZANO LPCC” Practice Location

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