Provider Demographics
NPI:1376669333
Name:TOMBERLIN, VALERIE LYNNE (LPCC)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:LYNNE
Last Name:TOMBERLIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CAMINO DE LA BUENA VIS
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-8816
Mailing Address - Country:US
Mailing Address - Phone:505-867-4919
Mailing Address - Fax:505-867-4919
Practice Address - Street 1:4308 CARLISLE BLVD NE
Practice Address - Street 2:#206
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4856
Practice Address - Country:US
Practice Address - Phone:505-507-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM#0971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59600OtherPRESBYTERIAN INSURANCE
NMA3992Medicaid
NM0971OtherLICENSE
NM12030502OtherCIGNA BEHAVIORAL HEALTH