MEDICARE: LEANDRA VALLEZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8434	SC

General Provider Information

NPI Number	:	1659093813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANDRA VALLEZ LPC

Provider Business Mailing Address
First Line	:	501 BELLE HALL PKWY UNIT 102
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-8322
Country	:	US
Telephone Number	:	843-885-4537
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 BELLE HALL PKWY UNIT 102
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-8322
Country	:	US
Telephone Number	:	843-885-4537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2022
Last Update Date	:	09/14/2022

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