Basic Information
Provider Information | |||||||||
NPI: | 1033436639 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PEROT | ||||||||
FirstName: | VALERIE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.ED., LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | P.O. BOX 13853 | ||||||||
Address2: |   | ||||||||
City: | ALEXANDRIA | ||||||||
State: | LA | ||||||||
PostalCode: | 713150000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3185215565 | ||||||||
FaxNumber: | 3182564171 | ||||||||
Practice Location | |||||||||
Address1: | 622 RIVERSIDE DRIVE | ||||||||
Address2: | CENTER FOR CHILDREN AND FAMILIES | ||||||||
City: | MONROE | ||||||||
State: | LA | ||||||||
PostalCode: | 71201 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3183980945 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/23/2010 | ||||||||
LastUpdateDate: | 06/14/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | 4566 | LA | Y |   | Other Service Providers | Case Manager/Care Coordinator |   |
ID Information
ID | Type | State | Issuer | Description | 1033436639 | 05 | LA |   | MEDICAID |