Healthcare Provider Details

I. General information

NPI: 1952179194
Provider Name (Legal Business Name): VALERIE TIJERINA LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD
LANSING MI
48910-6818
US

IV. Provider business mailing address

812 E JOLLY RD STE 210
LANSING MI
48910-6821
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8318
  • Fax:
Mailing address:
  • Phone: 517-237-7350
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: