Active NPI
David Gregory Valley, CSAC, CLA
- Counselor
- Ukiah, CA
National Provider Identifier
1669770426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 1135-031613A
- Practice address
- 3258 North State Street
Ukiah, CA 95482-3052 - Phone
- (707) 234-9472
- Fax
- (707) 463-2045
- NPI assigned
- Mar 3, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CORPHQ-1135-031613A | CA | |
| Mental Illness Community Based Residential Treatment Facility | 320800000X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1135-031613A | CA | |
| Counselor | 101Y00000X | 1135-031613A | CA | Primary |
Addresses
Primary practice location
3258 North State Street
Ukiah, CA 95482-3052
Mailing address
3258 North State Street
Ukiah, CA 95482-3052
Phone (707) 234-9472
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DMR0616 | Other | NATIONWIDE INSURANC | |
| 1135-031613A | Other | CA | AOD LICENSE |
| 45-4980495 | Other | IRS TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1135-031613A | CA | MD | Counselor |
| CORPHQ-1135-031613A | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339718400000",
"number": "1669770426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3258 NORTH STATE STREET",
"city": "UKIAH",
"state": "CA",
"postal_code": "954823052",
"telephone_number": "707-234-9472",
"fax_number": "707-463-2045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3258 NORTH STATE STREET",
"city": "UKIAH",
"state": "CA",
"postal_code": "954823052",
"telephone_number": "707-234-9472",
"fax_number": "707-463-2045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALLEY",
"first_name": "DAVID",
"middle_name": "GREGORY",
"name_prefix": "Mr.",
"credential": "CSAC, CLA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-03",
"last_updated": "2012-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "CORPHQ-1135-031613A",
"primary": false
},
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "1135-031613A",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "1135-031613A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONWIDE INSURANC",
"identifier": "DMR0616",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AOD LICENSE",
"identifier": "1135-031613A",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IRS TAX ID",
"identifier": "45-4980495",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Ukiah, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.