MEDICARE: VALLERY LUCILLE MANN M.A., L. L. P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	6301009527	MI

General Provider Information

NPI Number	:	1063431120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALLERY LUCILLE MANN M.A., L. L. P.

Provider Business Mailing Address
First Line	:	2945 16 MILE RD NE
Second Line	:
City	:	CEDAR SPRINGS
State	:	MI
Zip	:	49319-9446
Country	:	US
Telephone Number	:	616-550-7047
Fax Number	:	616-774-2875

Provider Business Practice Location Address
First Line	:	678 FRONT AVE NW
Second Line	:	SUITE 265
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-5325
Country	:	US
Telephone Number	:	616-774-2346
Fax Number	:	616-774-2875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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