Provider Demographics
NPI:1770953127
Name:VALLEY OF HOPE COUNSELING AGENCY LLC
Entity type:Organization
Organization Name:VALLEY OF HOPE COUNSELING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-436-9717
Mailing Address - Street 1:4609 N MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-2970
Mailing Address - Country:US
Mailing Address - Phone:318-436-9717
Mailing Address - Fax:
Practice Address - Street 1:4609 N MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-2970
Practice Address - Country:US
Practice Address - Phone:318-436-9717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health