Provider Demographics
NPI:1124357603
Name:JAURE, VIOLETA BLANCA (LPCC, LADAC)
Entity Type:Individual
Prefix:
First Name:VIOLETA
Middle Name:BLANCA
Last Name:JAURE
Suffix:
Gender:F
Credentials:LPCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNM HSC MSC09-5030 UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-5428
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:UNM DEPT OF PSYC MSC09-5030
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-2612
Practice Address - Country:US
Practice Address - Phone:505-272-5428
Practice Address - Fax:505-272-4921
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT0126411101YA0400X
NM0125741101YM0800X
NM0156311101YP2500X
390200000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03585522Medicaid