Provider Demographics
NPI:1407540628
Name:VELA, LINDSAY R
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:R
Last Name:VELA
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 1:280 E THOUSAND OAKS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7762
Mailing Address - Country:US
Mailing Address - Phone:805-630-3455
Mailing Address - Fax:
Practice Address - Street 1:280 E THOUSAND OAKS BLVD STE D
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7762
Practice Address - Country:US
Practice Address - Phone:805-890-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT84296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional