Provider Demographics
NPI:1558355081
Name:VALLE, JOSE MANUEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MANUEL
Last Name:VALLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3815
Mailing Address - Country:US
Mailing Address - Phone:208-602-2039
Mailing Address - Fax:208-442-0841
Practice Address - Street 1:804 3RD ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3815
Practice Address - Country:US
Practice Address - Phone:208-602-2039
Practice Address - Fax:208-442-0841
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 9491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical