Provider Demographics
NPI:1245083336
Name:VALENZUELA, CHERIE ANQUONAYE
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:ANQUONAYE
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 1:15433 FM 1325 APT 932
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-0019
Mailing Address - Country:US
Mailing Address - Phone:346-530-7571
Mailing Address - Fax:
Practice Address - Street 1:1205 SAM BASS RD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4247
Practice Address - Country:US
Practice Address - Phone:512-807-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician