Provider Demographics
NPI:1003545914
Name:VELASCO FAMILY COUNSELING AND THERAPY INC.
Entity Type:Organization
Organization Name:VELASCO FAMILY COUNSELING AND THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-334-2607
Mailing Address - Street 1:27 DARLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4300
Mailing Address - Country:US
Mailing Address - Phone:707-334-2607
Mailing Address - Fax:
Practice Address - Street 1:301 GEORGIA ST STE 125
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5984
Practice Address - Country:US
Practice Address - Phone:707-334-2607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty