1679622476 NPI number — VALORIE LYNN DE LENA M.A., MFT

Table of content: VALORIE LYNN DE LENA M.A., MFT (NPI 1679622476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679622476 NPI number — VALORIE LYNN DE LENA M.A., MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LENA
Provider First Name:
VALORIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MICKELS
Provider Other First Name:
VALORIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679622476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3468 MT DIABLO BLVD
Provider Second Line Business Mailing Address:
SUITE B-201
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94549-3957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-295-0342
Provider Business Mailing Address Fax Number:
925-284-1599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3468 MT DIABLO BLVD
Provider Second Line Business Practice Location Address:
SUITE B-301
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94549-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-295-0342
Provider Business Practice Location Address Fax Number:
925-284-1599
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 42456 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19-246-0 . This is a "CC CO. DEPT HUMAN SVCS." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 09036 . This is a "MEDI-CAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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