Provider Demographics
NPI:1124223623
Name:VALLERAND, ROLAND N (MFT)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:N
Last Name:VALLERAND
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-1133
Mailing Address - Country:US
Mailing Address - Phone:661-322-1528
Mailing Address - Fax:661-852-2877
Practice Address - Street 1:4900 CALIFORNIA AVE
Practice Address - Street 2:TOWERA SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7024
Practice Address - Country:US
Practice Address - Phone:661-852-2715
Practice Address - Fax:661-852-2877
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19211261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)