| Vaillancourt Associates Llc | |
|
304 W Griggs Ave Ste C Las Cruces NM 88005-2603 | |
| (575) 405-7146 | |
| (575) 405-5446 |
| Full Name | Vaillancourt Associates Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 304 W Griggs Ave Ste C, Las Cruces, New Mexico |
| Authorized Official Name and Position | Kourtney T Vaillancourt (OWNER) |
| Authorized Official Contact | 5753126085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vaillancourt Associates Llc 619 N Alameda Blvd Las Cruces NM 88005-2130 Ph: (575) 405-7146 | Vaillancourt Associates Llc 304 W Griggs Ave Ste C Las Cruces NM 88005-2603 Ph: (575) 405-7146 |
| NPI Number | 1063859015 |
|---|---|
| Provider Enumeration Date | 05/31/2013 |
| Last Update Date | 01/19/2024 |
| Certification Date | 01/19/2024 |
| Medicare PECOS PAC ID | 5799129409 |
|---|---|
| Medicare Enrollment ID | O20240221003261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063859015 | NPI | - | NPPES |
| 80302386 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 0109041 (New Mexico) | Primary |
| Provider Name | Amanda Pando |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1487392247 PECOS PAC ID: 2062851975 Enrollment ID: I20240411002137 |
| Provider Name | Neysla Cisneros |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1649752718 PECOS PAC ID: 7517307416 Enrollment ID: I20240425001503 |
| Provider Name | Miriam Juarez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1245656966 PECOS PAC ID: 0749621241 Enrollment ID: I20240515002204 |
| Provider Name | Melinda Paolone |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1730608662 PECOS PAC ID: 6305288697 Enrollment ID: I20240531003504 |
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