1376669333 NPI number — MS. VALERIE LYNNE TOMBERLIN LPCC

Table of content: MS. VALERIE LYNNE TOMBERLIN LPCC (NPI 1376669333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376669333 NPI number — MS. VALERIE LYNNE TOMBERLIN LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOMBERLIN
Provider First Name:
VALERIE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376669333
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:
56 CAMINO DE LA BUENA VIS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLACITAS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87043-8816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-867-4919
Provider Business Mailing Address Fax Number:
505-867-4919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4308 CARLISLE BLVD NE
Provider Second Line Business Practice Location Address:
#206
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87107-4856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-507-0377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2007

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: 101YM0800X , with the licence number:  #0971 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 59600 . This is a "PRESBYTERIAN INSURANCE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: A3992 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0971 . This is a "LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 12030502 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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