Provider Demographics
NPI:1477283166
Name:FOUTTY, VALARREE IRENE
Entity Type:Individual
Prefix:
First Name:VALARREE
Middle Name:IRENE
Last Name:FOUTTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 W PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2566
Mailing Address - Country:US
Mailing Address - Phone:330-606-5999
Mailing Address - Fax:
Practice Address - Street 1:23360 CHAGRIN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5537
Practice Address - Country:US
Practice Address - Phone:216-242-6662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health