Provider Demographics
NPI:1881192839
Name:LYSTRUP, VALORIE LYNN (CADC, CPGC-I)
Entity Type:Individual
Prefix:
First Name:VALORIE
Middle Name:LYNN
Last Name:LYSTRUP
Suffix:
Gender:F
Credentials:CADC, CPGC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9965 W TROPICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1471
Mailing Address - Country:US
Mailing Address - Phone:702-326-9904
Mailing Address - Fax:
Practice Address - Street 1:1681 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3494
Practice Address - Country:US
Practice Address - Phone:702-476-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00681-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)