Provider Demographics
NPI:1508314261
Name:VALENZUELA, JESUS JR (MA, LMFT, CAS)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:VALENZUELA
Suffix:JR
Gender:M
Credentials:MA, LMFT, CAS
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:VALENZUELA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:LMFT, CAS
Mailing Address - Street 1:4601 CORBETT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9579
Mailing Address - Country:US
Mailing Address - Phone:970-207-4857
Mailing Address - Fax:970-495-8910
Practice Address - Street 1:4601 CORBETT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-9579
Practice Address - Country:US
Practice Address - Phone:970-207-4857
Practice Address - Fax:970-495-8910
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO.0002051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health