Provider Demographics
NPI:1083980361
Name:MYRNA I. VALLE, LMHC PA
Entity Type:Organization
Organization Name:MYRNA I. VALLE, LMHC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:I
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-786-3100
Mailing Address - Street 1:14505 BRUCE B. DOWNS BLVD.
Mailing Address - Street 2:
Mailing Address - City:TAMPS
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2789
Mailing Address - Country:US
Mailing Address - Phone:813-786-3100
Mailing Address - Fax:813-910-7828
Practice Address - Street 1:14505 BRUCE B. DOWNS BLVD.
Practice Address - Street 2:
Practice Address - City:TAMPS
Practice Address - State:FL
Practice Address - Zip Code:33613-2789
Practice Address - Country:US
Practice Address - Phone:813-786-3100
Practice Address - Fax:813-910-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty