Provider Demographics
NPI:1871815506
Name:VALENTINE, TRACI ASTRID (MED, MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:ASTRID
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MED, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6053 HUDSON RD STE 152
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1015
Mailing Address - Country:US
Mailing Address - Phone:651-373-3886
Mailing Address - Fax:
Practice Address - Street 1:6053 HUDSON RD STE 152
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1015
Practice Address - Country:US
Practice Address - Phone:651-373-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist