Provider Demographics
NPI:1205545662
Name:PONCE, GRACIELA (LPCC)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:GRACIELA
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
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 1:18420 S HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:NM
Practice Address - Zip Code:88044-9605
Practice Address - Country:US
Practice Address - Phone:575-233-3830
Practice Address - Fax:575-233-4542
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0204121101YM0800X
NMCTB-2024-0609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health