Provider Demographics
NPI:1376378463
Name:VALENTINE, MICHAEL J (PHD, LPC, BC-TMH)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:PHD, LPC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 ROCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-8739
Mailing Address - Country:US
Mailing Address - Phone:662-617-1781
Mailing Address - Fax:
Practice Address - Street 1:1458 ROCK HILL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-8739
Practice Address - Country:US
Practice Address - Phone:662-617-1781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional