Provider Demographics
NPI:1063431120
Name:MANN, VALLERY LUCILLE (MA, L L P)
Entity type:Individual
Prefix:
First Name:VALLERY
Middle Name:LUCILLE
Last Name:MANN
Suffix:
Gender:F
Credentials:MA, L L P
Other - Prefix:
Other - First Name:VALLERY
Other - Middle Name:LUCILLE
Other - Last Name:TOVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:2945 16 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-9446
Mailing Address - Country:US
Mailing Address - Phone:616-550-7047
Mailing Address - Fax:616-774-2875
Practice Address - Street 1:678 FRONT AVE NW
Practice Address - Street 2:SUITE 265
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5325
Practice Address - Country:US
Practice Address - Phone:616-774-2346
Practice Address - Fax:616-774-2875
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009527103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling