Provider Demographics
NPI:1548932874
Name:VALLIS, EMILY LAUREN
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:LAUREN
Last Name:VALLIS
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 1:200 CAHABA PARK CIR STE 116
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5041
Mailing Address - Country:US
Mailing Address - Phone:262-510-5111
Mailing Address - Fax:855-380-3591
Practice Address - Street 1:200 CAHABA PARK CIR STE 116
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5041
Practice Address - Country:US
Practice Address - Phone:262-510-5111
Practice Address - Fax:855-380-3591
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician