Provider Demographics
NPI:1891739876
Name:VALLEJO, GABRIEL G (LPC-S, NCC)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:G
Last Name:VALLEJO
Suffix:
Gender:M
Credentials:LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2361
Mailing Address - Country:US
Mailing Address - Phone:928-595-1428
Mailing Address - Fax:
Practice Address - Street 1:401 PICACHO RD
Practice Address - Street 2:
Practice Address - City:WINTERHAVEN
Practice Address - State:CA
Practice Address - Zip Code:92283-9605
Practice Address - Country:US
Practice Address - Phone:760-572-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC-20296101YM0800X, 101YP2500X
AZLPC-20880101YP2500X
AZLPC-15087101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health