Provider Demographics
NPI:1699483255
Name:VALENTINE, MARISSA CLAIRE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:CLAIRE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:AULT
Mailing Address - State:CO
Mailing Address - Zip Code:80610-0298
Mailing Address - Country:US
Mailing Address - Phone:970-443-1725
Mailing Address - Fax:
Practice Address - Street 1:2550 STOVER ST BLDG C
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4641
Practice Address - Country:US
Practice Address - Phone:970-443-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional