Basic Information
Provider Information
NPI: 1689054355
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VALDEZ
FirstName: AURIEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4851 INDEPENDENCE ST
Address2: SUITE 200
City: WHEAT RIDGE
State: CO
PostalCode: 800336715
CountryCode: US
TelephoneNumber: 3034250300
FaxNumber: 3034325071
Practice Location
Address1: 12751 W 56TH PL
Address2:  
City: ARVADA
State: CO
PostalCode: 800021327
CountryCode: US
TelephoneNumber: 3034244136
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/08/2015
LastUpdateDate: 06/08/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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