Provider Demographics
NPI:1639291230
Name:DERSCH-BALDONADO, KELI MAUREEN (LPCC)
Entity type:Individual
Prefix:MRS
First Name:KELI
Middle Name:MAUREEN
Last Name:DERSCH-BALDONADO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12124 STATE HIGHWAY 14 N
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9313
Mailing Address - Country:US
Mailing Address - Phone:505-250-8119
Mailing Address - Fax:505-281-3557
Practice Address - Street 1:12124 STATE HIGHWAY 14 N
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9313
Practice Address - Country:US
Practice Address - Phone:505-250-8119
Practice Address - Fax:505-281-3557
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0099941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional