Provider Demographics
NPI:1043446925
Name:VALDEZ, MARY JANE (LPC,CACIII,NCACII)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:LPC,CACIII,NCACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2541
Mailing Address - Country:US
Mailing Address - Phone:719-589-2974
Mailing Address - Fax:719-589-2974
Practice Address - Street 1:811 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2541
Practice Address - Country:US
Practice Address - Phone:719-589-2974
Practice Address - Fax:719-589-2974
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPC-620OtherLPC-620, CACIII1446
CO035342Medicaid