Provider Demographics
NPI:1376829317
Name:VALDEVIT, BORIS A (LPCC)
Entity Type:Individual
Prefix:MR
First Name:BORIS
Middle Name:A
Last Name:VALDEVIT
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 LUJAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-6302
Mailing Address - Country:US
Mailing Address - Phone:575-635-0390
Mailing Address - Fax:
Practice Address - Street 1:2402 SOUTH LOCUST STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001
Practice Address - Country:US
Practice Address - Phone:575-521-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0794101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health