Provider Demographics
NPI:1598188955
Name:JUAN PABLO VALBUENA, PSYD, PLLC
Entity Type:Organization
Organization Name:JUAN PABLO VALBUENA, PSYD, PLLC
Other - Org Name:JUAN PABLO VALBUENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:PABLO
Authorized Official - Last Name:VALBUENA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:425-954-3453
Mailing Address - Street 1:2319 N 45TH ST
Mailing Address - Street 2:#106
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6982
Mailing Address - Country:US
Mailing Address - Phone:425-954-3453
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST
Practice Address - Street 2:#106
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6982
Practice Address - Country:US
Practice Address - Phone:425-954-3453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60254025103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty