Healthcare Provider Details

I. General information

NPI: 1043831886
Provider Name (Legal Business Name): VALTINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 W US HIGHWAY 50 STE 105
SALIDA CO
81201-9354
US

IV. Provider business mailing address

9150 COUNTY ROAD 240
SALIDA CO
81201-9216
US

V. Phone/Fax

Practice location:
  • Phone: 719-257-3033
  • Fax:
Mailing address:
  • Phone: 719-257-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE DURICY
Title or Position: CO-OWNER/THERAPIST
Credential: LCSW
Phone: 719-257-3033