Provider Demographics
NPI:1821531377
Name:VALLERY, TERALYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:TERALYNN
Middle Name:
Last Name:VALLERY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11813 ROAD 27.1
Mailing Address - Street 2:
Mailing Address - City:DOLORES
Mailing Address - State:CO
Mailing Address - Zip Code:81323-9247
Mailing Address - Country:US
Mailing Address - Phone:970-779-0699
Mailing Address - Fax:
Practice Address - Street 1:11813 ROAD 27.1
Practice Address - Street 2:
Practice Address - City:DOLORES
Practice Address - State:CO
Practice Address - Zip Code:81323-9247
Practice Address - Country:US
Practice Address - Phone:970-779-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-20-46155103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty