Provider Demographics
NPI:1609210764
Name:VALLEJO, KRISTHEL
Entity type:Individual
Prefix:
First Name:KRISTHEL
Middle Name:
Last Name:VALLEJO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 SW 13TH ST
Mailing Address - Street 2:APT. 211G
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2160
Mailing Address - Country:US
Mailing Address - Phone:305-915-6464
Mailing Address - Fax:
Practice Address - Street 1:7031 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3864
Practice Address - Country:US
Practice Address - Phone:954-276-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17258101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health