Healthcare Provider Details

I. General information

NPI: 1649770900
Provider Name (Legal Business Name): JULIE CHRISTINE VALIQUETTE MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E PACIFIC COAST HWY STE 320
LONG BEACH CA
90804-3271
US

IV. Provider business mailing address

4500 E PACIFIC COAST HWY STE 320
LONG BEACH CA
90804-3271
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99657
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number123813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: