Healthcare Provider Details

I. General information

NPI: 1033948815
Provider Name (Legal Business Name): CIERRA VALLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 LIVERNOIS ST STE 214
FERNDALE MI
48220-2675
US

IV. Provider business mailing address

604 W MARSHALL ST
FERNDALE MI
48220-1855
US

V. Phone/Fax

Practice location:
  • Phone: 313-484-0331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451023651
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: