Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ACD.0000672 | CO |
NPI | 1053788711 |
---|---|
Provider Name | Tamera Ann Valentine |
First Address | La Jara, CO 81140-9584 |
Second Address | La Jara, CO 81140-9584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2015 |
Last Update Date | 17/10/2016 |