Provider Demographics
NPI:1205042934
Name:VANERON, VALLI (MS)
Entity Type:Individual
Prefix:
First Name:VALLI
Middle Name:
Last Name:VANERON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 WESTGATE CIR
Mailing Address - Street 2:107
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8019
Mailing Address - Country:US
Mailing Address - Phone:615-467-6333
Mailing Address - Fax:
Practice Address - Street 1:1616 WESTGATE CIR
Practice Address - Street 2:107
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8019
Practice Address - Country:US
Practice Address - Phone:615-467-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4135486OtherBLUE CROSS PROVIDER ID #