Basic Information
| Provider Information | |||||||||
| NPI: | 1073697975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLANUEVA | ||||||||
| FirstName: | JULIANN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 CREST POINT DR | ||||||||
| Address2: | |||||||||
| City: | PORTALES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 881309057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057490651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 W FIR ST | ||||||||
| Address2: | |||||||||
| City: | PORTALES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 881305826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753565112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 0122481 | NM | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.