Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301009527 | MI |
NPI | 1063431120 |
---|---|
Provider Name | Vallery Lucille Mann |
First Address | Cedar Springs, MI 49319-9446 |
Second Address | Grand Rapids, MI 49504-5325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |