Provider Demographics
NPI:1033863956
Name:VELAZQUEZ- RUIZ, MIRELLA
Entity Type:Individual
Prefix:
First Name:MIRELLA
Middle Name:
Last Name:VELAZQUEZ- RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 KRAMER LN STE 150
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4096
Mailing Address - Country:US
Mailing Address - Phone:512-572-0157
Mailing Address - Fax:
Practice Address - Street 1:2100 KRAMER LN STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4096
Practice Address - Country:US
Practice Address - Phone:512-572-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4834103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst