Individual
DR. KOURTNEY T. VAILLANCOURT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D, LMFT, LADAC
Contact information
Practice address
619 N ALAMEDA BLVD, LAS CRUCES, NM 88005-2130
(575) 405-7146
(575) 405-5446
Mailing address
619 N ALAMEDA BLVD, LAS CRUCES, NM 88005-2130
(575) 405-7146
(575) 405-5446
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0109031
NM
101YM0800X
Mental Health Counselor
0102221
NM
106H00000X
Marriage & Family Therapist
Primary
0109041
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80302386
—
NM
Enumeration date
08/20/2007
Last updated
11/16/2023
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