Healthcare Provider Details

I. General information

NPI: 1669916037
Provider Name (Legal Business Name): KATHY VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 AVENUE D
SCOTTSBLUFF NE
69361-4650
US

IV. Provider business mailing address

115 W RAILWAY ST
SCOTTSBLUFF NE
69361-3177
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-3171
  • Fax: 308-635-9672
Mailing address:
  • Phone: 308-672-6587
  • Fax: 308-365-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1387
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: