Provider Demographics
NPI:1619432143
Name:VALLERY, CRISSA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:CRISSA
Middle Name:JEAN
Last Name:VALLERY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-6530
Mailing Address - Country:US
Mailing Address - Phone:409-790-5445
Mailing Address - Fax:
Practice Address - Street 1:2895 S 8TH ST BLDG F
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-7722
Practice Address - Country:US
Practice Address - Phone:409-839-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional