Provider Demographics
NPI:1437830635
Name:ACEVEDO, VALERIA MELANIE
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:MELANIE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15503 VANCE JACKSON RD APT 1206
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3198
Mailing Address - Country:US
Mailing Address - Phone:210-350-9831
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE COURT DR STE 201
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4936
Practice Address - Country:US
Practice Address - Phone:505-207-8929
Practice Address - Fax:505-365-2902
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health