Healthcare Provider Details

I. General information

NPI: 1962629899
Provider Name (Legal Business Name): VALLERIE ELIZABETH COLEMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W CARLISLE RD
THOUSAND OAKS CA
91361-5314
US

IV. Provider business mailing address

5655 LINDERO CANYON RD STE 726
WESTLAKE VILLAGE CA
91362-4068
US

V. Phone/Fax

Practice location:
  • Phone: 310-367-2592
  • Fax:
Mailing address:
  • Phone: 310-367-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12592
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY12592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: