Healthcare Provider Details

I. General information

NPI: 1407207822
Provider Name (Legal Business Name): JESSE VALDEZ PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 W 20TH ST UNIT 212
GREELEY CO
80634-9640
US

IV. Provider business mailing address

5260 FOSSIL CREEK PARKWAY UNIT #9107
FORT COLLINS CO
80525
US

V. Phone/Fax

Practice location:
  • Phone: 970-341-4322
  • Fax:
Mailing address:
  • Phone: 505-429-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: