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General NPI Number Information
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NPI Number | 1053788711
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Entity Type | Individual
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Provider Name | TAMERA ANN VALENTINE MA, LMFTC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 401 MAIN STREET
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City | LA JARA
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State | CO
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Zip | 81140-9584
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Country | US
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Telephone | 719-992-4260
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Fax |
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Provider Business Mailing Address
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Address Line | 14385 COUNTY ROAD P
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City | LA JARA
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State | CO
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Zip | 81140-9584
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Country | US
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Telephone | 719-992-4260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | ACD.0000672
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT.0001353
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License Number State | CO
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