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General NPI Number Information
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NPI Number | 1144621897
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Entity Type | Individual
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Provider Name | KAITLYN NICOLE VALDEZ MA
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Gender | Female
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 470 CHADBOURNE RD
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City | FAIRFIELD
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State | CA
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Zip | 94534-9600
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Country | US
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Telephone | 707-628-8081
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Fax |
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Provider Business Mailing Address
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Address Line | 470 CHADBOURNE ROAD
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City | FAIRFIELD
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State | CA
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Zip | 94533
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Country | US
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Telephone | 707-628-8081
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMF91026
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PCC12571
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License Number State | CA
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