Provider Demographics
NPI:1316494446
Name:VALENZUELA, CARLA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33180 W 82ND ST
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:KS
Mailing Address - Zip Code:66018-8012
Mailing Address - Country:US
Mailing Address - Phone:913-972-4377
Mailing Address - Fax:
Practice Address - Street 1:33180 W 82ND ST
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:KS
Practice Address - Zip Code:66018-8012
Practice Address - Country:US
Practice Address - Phone:913-972-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst