Healthcare Provider Details

I. General information

NPI: 1942428768
Provider Name (Legal Business Name): JACQUELYN VALENZUELA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17121 SE 270TH PL SUITE 205
COVINGTON WA
98042-5431
US

IV. Provider business mailing address

17121 SE 270TH PL SUITE 205
COVINGTON WA
98042-5431
US

V. Phone/Fax

Practice location:
  • Phone: 253-638-9988
  • Fax: 253-638-7465
Mailing address:
  • Phone: 253-638-9988
  • Fax: 253-638-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00005515
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: