Provider Demographics
NPI:1053821785
Name:DE LA PAZ, HELENA (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:
Last Name:DE LA PAZ
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:HELENA
Other - Middle Name:
Other - Last Name:DE LA PAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:1805 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6300 RIVERSIDE PLAZA LN NW STE 100
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1908
Practice Address - Country:US
Practice Address - Phone:505-395-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0192691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health