Provider Demographics
NPI:1003613936
Name:VILLAGRACIA, BELEN DE LEON (LMHC)
Entity type:Individual
Prefix:
First Name:BELEN
Middle Name:DE LEON
Last Name:VILLAGRACIA
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:BELEN
Other - Middle Name:DE MESA
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1419 S SANTA BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-5361
Mailing Address - Country:US
Mailing Address - Phone:575-936-4227
Mailing Address - Fax:
Practice Address - Street 1:1419 S SANTA BARBARA ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5361
Practice Address - Country:US
Practice Address - Phone:575-936-4227
Practice Address - Fax:575-936-4658
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2025-0063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health