Healthcare Provider Details

I. General information

NPI: 1386211803
Provider Name (Legal Business Name): JESUS VALIENTE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14301 N INTERSTATE 35 APT 2103
PFLUGERVILLE TX
78660-4621
US

IV. Provider business mailing address

14301 N INTERSTATE 35 APT 2103
PFLUGERVILLE TX
78660-4621
US

V. Phone/Fax

Practice location:
  • Phone: 512-541-8612
  • Fax:
Mailing address:
  • Phone: 512-541-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number77610
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77610
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: