Healthcare Provider Details

I. General information

NPI: 1437419231
Provider Name (Legal Business Name): VALERIE KIM BRAUKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S MAIN ST SUITE 1100
ORANGE CA
92868-4507
US

IV. Provider business mailing address

500 S MAIN ST SUITE 1100
ORANGE CA
92868-4507
US

V. Phone/Fax

Practice location:
  • Phone: 714-955-6558
  • Fax: 714-543-4398
Mailing address:
  • Phone: 714-955-6558
  • Fax: 714-543-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: