Provider Demographics
NPI:1932332657
Name:NEWSOM, VERONICA JADE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:JADE
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:J
Other - Last Name:VALDIVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:1027 E QUEEN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-3365
Mailing Address - Country:US
Mailing Address - Phone:323-219-7237
Mailing Address - Fax:323-471-1612
Practice Address - Street 1:1027 E QUEEN AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-3365
Practice Address - Country:US
Practice Address - Phone:323-219-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT88229106H00000X
ORT2241106H00000X
MTBBH-LMFT-LIC-57066106H00000X
UT13376063-3902106H00000X
WALF60945794106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist