Provider Demographics
NPI:1508341512
Name:HERNANDEZ VALDEZ, KARI (LPCC)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:HERNANDEZ VALDEZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1380 RIO RANCHO BLVD SE # 453
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1006
Mailing Address - Country:US
Mailing Address - Phone:505-226-2740
Mailing Address - Fax:
Practice Address - Street 1:1380 RIO RANCHO BLVD SE # 453
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1006
Practice Address - Country:US
Practice Address - Phone:505-226-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0225571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM53804503Medicaid