Provider Demographics
NPI:1720539745
Name:VALEO BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:VALEO BEHAVIORAL HEALTH, LLC
Other - Org Name:KRISTINA M MINER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC, MSW
Authorized Official - Phone:406-544-7678
Mailing Address - Street 1:1600 NORTH AVE W STE 106
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5500
Mailing Address - Country:US
Mailing Address - Phone:406-544-7678
Mailing Address - Fax:406-926-3117
Practice Address - Street 1:1600 NORTH AVE W STE 106
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5500
Practice Address - Country:US
Practice Address - Phone:406-544-7678
Practice Address - Fax:406-926-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-999251S00000X
MTBBH-LAC-LIC-1354251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1538473004Medicaid