Basic Information
| Provider Information | |||||||||
| NPI: | 1124357603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAURE | ||||||||
| FirstName: | VIOLETA | ||||||||
| MiddleName: | BLANCA | ||||||||
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| Credential: | LPCC, LADAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNM HSC MSC09-5030 UNIVERSITY OF NEW MEXICO | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725428 | ||||||||
| FaxNumber: | 5052728060 | ||||||||
| Practice Location | |||||||||
| Address1: | UNM DEPT OF PSYC MSC09-5030 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871312612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725428 | ||||||||
| FaxNumber: | 5052724921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2009 | ||||||||
| LastUpdateDate: | 04/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | T0126411 | NM | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 0125741 | NM | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 0156311 | NM | N | Behavioral Health & Social Service Providers | Counselor | Professional | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | NM | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 03585522 | 05 | NM | MEDICAID |