Provider Demographics
NPI:1053788711
Name:VALENTINE, TAMERA ANN (MA, LMFTC)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:ANN
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MA, LMFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14385 COUNTY ROAD P
Mailing Address - Street 2:
Mailing Address - City:LA JARA
Mailing Address - State:CO
Mailing Address - Zip Code:81140-9584
Mailing Address - Country:US
Mailing Address - Phone:719-992-4260
Mailing Address - Fax:
Practice Address - Street 1:401 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LA JARA
Practice Address - State:CO
Practice Address - Zip Code:81140-9584
Practice Address - Country:US
Practice Address - Phone:719-992-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000672103TA0400X
COMFT.0001353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)