Provider Demographics
NPI:1356447239
Name:PAREDES, EMILY JEAN (LDAC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JEAN
Last Name:PAREDES
Suffix:
Gender:F
Credentials:LDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 CALLE DE ALEGRA STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3423
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:100 W GRIGGS AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1234
Practice Address - Country:US
Practice Address - Phone:575-647-2800
Practice Address - Fax:575-647-2898
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4314101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM850204142OtherMEDICARE
NM850204142OtherMEDICARE
NM47043Medicaid