Provider Demographics
NPI:1073697975
Name:VILLANUEVA, JULIANN R (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JULIANN
Middle Name:R
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CREST POINT DR
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-9057
Mailing Address - Country:US
Mailing Address - Phone:505-749-0651
Mailing Address - Fax:
Practice Address - Street 1:1111 W FIR ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-5826
Practice Address - Country:US
Practice Address - Phone:575-356-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0122481106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist