Provider Demographics
NPI:1730302944
Name:IRVIN, VALARAY J (PHD)
Entity Type:Individual
Prefix:
First Name:VALARAY
Middle Name:J
Last Name:IRVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 E WORTHY ST STE E
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4369
Mailing Address - Country:US
Mailing Address - Phone:225-644-3188
Mailing Address - Fax:225-647-0658
Practice Address - Street 1:1056 E WORTHY ST STE E
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4369
Practice Address - Country:US
Practice Address - Phone:225-644-3188
Practice Address - Fax:225-647-0658
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health