Healthcare Provider Details

I. General information

NPI: 1851202188
Provider Name (Legal Business Name): KARLY MARIE VALENZUELA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 E SPEEDWAY BLVD STE 120
TUCSON AZ
85719-4762
US

IV. Provider business mailing address

9750 N ORACLE RD APT 3106
ORO VALLEY AZ
85704-7627
US

V. Phone/Fax

Practice location:
  • Phone: 520-372-2672
  • Fax:
Mailing address:
  • Phone: 412-628-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-08496T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: