Provider Demographics
NPI:1639277064
Name:VALENZUELA MONCIBAIZ, GRACIELA MARIA (MA, LPC-S)
Entity type:Individual
Prefix:MS
First Name:GRACIELA
Middle Name:MARIA
Last Name:VALENZUELA MONCIBAIZ
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8408 DAVIS BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-8610
Mailing Address - Country:US
Mailing Address - Phone:817-765-5664
Mailing Address - Fax:817-918-7307
Practice Address - Street 1:8408 DAVIS BLVD STE 240
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8610
Practice Address - Country:US
Practice Address - Phone:817-765-5664
Practice Address - Fax:817-918-7307
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16499101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional