Most Relevant Information
Provider Data
| NPI Number: | 1003009432 |
| Provider Name: | KOURTNEY T. VAILLANCOURT PH.D, LMFT, LADAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 0109031 |
Most Important Dates
| Enumeration Date: | 08/20/2007 |
| Last Updated: | 11/16/2023 |
Provider Practice Location
619 N ALAMEDA BLVD
LAS CRUCES
NM
880052130
Practice Location Phone/Fax
| Phone: | 5754057146 |
| Fax: | 5754055446 |
Provider Mailing Location
619 N ALAMEDA BLVD
LAS CRUCES
NM
880052130
Provider Mailing Phone/Fax
| Phone: | 5754057146 |
| Fax: | 5754055446 |