Provider Demographics
NPI:1164918132
Name:VALLETTO, BRIE (MED)
Entity Type:Individual
Prefix:MISS
First Name:BRIE
Middle Name:
Last Name:VALLETTO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:BRIE
Other - Middle Name:
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2460 W 26TH AVE STE 30C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5340
Mailing Address - Country:US
Mailing Address - Phone:720-306-1383
Mailing Address - Fax:
Practice Address - Street 1:2460 W 26TH AVE STE 30C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5340
Practice Address - Country:US
Practice Address - Phone:720-306-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-48653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional