Provider Demographics
NPI:1275344640
Name:VALLE, MARIA-THERERESA C (AMFT)
Entity type:Individual
Prefix:
First Name:MARIA-THERERESA
Middle Name:C
Last Name:VALLE
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:VALLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4825 S 850 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4792
Mailing Address - Country:US
Mailing Address - Phone:707-694-8885
Mailing Address - Fax:
Practice Address - Street 1:5929 FASHION POINT DR STE 210
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4683
Practice Address - Country:US
Practice Address - Phone:385-333-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14197025-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist