Healthcare Provider Details

I. General information

NPI: 1851882518
Provider Name (Legal Business Name): MAISSIE VALIYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 N MERIDIAN ST
INDIANAPOLIS IN
46208-5728
US

IV. Provider business mailing address

1575 DR MARTIN LUTHER KING JR ST
INDIANAPOLIS IN
46202-2295
US

V. Phone/Fax

Practice location:
  • Phone: 260-245-1455
  • Fax: 317-634-6341
Mailing address:
  • Phone: 317-644-7243
  • Fax: 317-644-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: