Provider Demographics
NPI:1619443496
Name:VALENTINE, LAUREN RAE (AMFT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:RAE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BEACON WAY
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2699
Mailing Address - Country:US
Mailing Address - Phone:949-584-6886
Mailing Address - Fax:
Practice Address - Street 1:327 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3509
Practice Address - Country:US
Practice Address - Phone:949-584-6886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT107565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist