Provider Demographics
NPI:1659672657
Name:SHORE, VALERIE K (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:K
Last Name:SHORE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50991 WASHINGTON ST STE A-144
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2889
Mailing Address - Country:US
Mailing Address - Phone:310-285-6611
Mailing Address - Fax:
Practice Address - Street 1:78115 CALLE ESTADO STE 201
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-3919
Practice Address - Country:US
Practice Address - Phone:310-285-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47412101Y00000X, 101YM0800X, 101YP2500X
CAMFC 47412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional