Provider Demographics
NPI:1073860581
Name:VELIZ, THEDY OSCAR (MA, LMFT #90276)
Entity Type:Individual
Prefix:MR
First Name:THEDY
Middle Name:OSCAR
Last Name:VELIZ
Suffix:
Gender:M
Credentials:MA, LMFT #90276
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N SANTA CRUZ AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7277
Mailing Address - Country:US
Mailing Address - Phone:408-412-9530
Mailing Address - Fax:
Practice Address - Street 1:330 N SANTA CRUZ AVE STE B
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7277
Practice Address - Country:US
Practice Address - Phone:408-412-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT90276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist