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General NPI Number Information
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NPI Number | 1588258057
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Entity Type | Organization
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Legal Business Name | MICHAEL J. VALLEJO
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Dates
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Enumeration Date | 02/25/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 6745 RANGEWOOD DR STE 108
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-7332
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Country | US
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Telephone | 503-728-6211
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Fax |
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Provider Business Mailing Address
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Address Line | 6745 RANGEWOOD DR STE 108
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-7332
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Country | US
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Telephone | 503-728-6211
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JOHN VALLEJO
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Credential | LCSW
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Telephone | 503-728-6211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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