Provider Demographics
NPI:1376016055
Name:VELA, CHRISTY ANN (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ANN
Last Name:VELA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4310
Mailing Address - Country:US
Mailing Address - Phone:817-846-7197
Mailing Address - Fax:
Practice Address - Street 1:4314 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4310
Practice Address - Country:US
Practice Address - Phone:972-670-3878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional