Provider Demographics
NPI:1710016456
Name:WANT, VALERIE
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:WANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25431 CABOT RD
Mailing Address - Street 2:STE. 111
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5518
Mailing Address - Country:US
Mailing Address - Phone:949-457-9571
Mailing Address - Fax:949-457-8169
Practice Address - Street 1:25431 CABOT RD
Practice Address - Street 2:STE. 111
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5518
Practice Address - Country:US
Practice Address - Phone:949-457-9571
Practice Address - Fax:949-457-8169
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15986103T00000X
CAPSY#15986103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist