Healthcare Provider Details

I. General information

NPI: 1457075343
Provider Name (Legal Business Name): SUSIE VALLE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20800 LAKE CHABOT RD APT 232
CASTRO VALLEY CA
94546-5437
US

IV. Provider business mailing address

PO BOX 20232
CASTRO VALLEY CA
94546-8232
US

V. Phone/Fax

Practice location:
  • Phone: 209-765-6136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: