Provider Demographics
NPI:1376093138
Name:UELAND, EDDEANA (LADAC)
Entity type:Individual
Prefix:
First Name:EDDEANA
Middle Name:
Last Name:UELAND
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 DE MOSS ST
Mailing Address - Street 2:
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2617
Mailing Address - Country:US
Mailing Address - Phone:575-572-8384
Mailing Address - Fax:575-597-2651
Practice Address - Street 1:3200 32ND STREET BYP
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7802
Practice Address - Country:US
Practice Address - Phone:575-597-2265
Practice Address - Fax:575-597-2651
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4110101YA0400X
NM0105891101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85281352Medicaid