Provider Demographics
NPI:1780120899
Name:VALLO, JOEY (CPSW)
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:VALLO
Suffix:
Gender:M
Credentials:CPSW
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 328
Mailing Address - Street 2:
Mailing Address - City:ACOMA
Mailing Address - State:NM
Mailing Address - Zip Code:87034-0328
Mailing Address - Country:US
Mailing Address - Phone:505-552-6661
Mailing Address - Fax:505-552-6426
Practice Address - Street 1:45 PINSBARRI DR
Practice Address - Street 2:
Practice Address - City:ACOMA
Practice Address - State:NM
Practice Address - Zip Code:87034-0328
Practice Address - Country:US
Practice Address - Phone:505-552-6661
Practice Address - Fax:505-552-6426
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor