Provider Demographics
NPI:1447590013
Name:DE LEON, CONSUELO V (LMHC)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:V
Last Name:DE LEON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 WESTMORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7352
Mailing Address - Country:US
Mailing Address - Phone:575-642-6409
Mailing Address - Fax:
Practice Address - Street 1:1401 S DON ROSER DR STE F1
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4577
Practice Address - Country:US
Practice Address - Phone:575-522-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0155521101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor