Provider Demographics
NPI:1154706133
Name:WATERLAND, VALERIE (MS MFT)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:WATERLAND
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 LEGION WAY SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1518
Mailing Address - Country:US
Mailing Address - Phone:360-581-6982
Mailing Address - Fax:
Practice Address - Street 1:809 LEGION WAY SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1518
Practice Address - Country:US
Practice Address - Phone:360-581-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60482122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist