Provider Demographics
NPI:1437709623
Name:VELA, VICTORIA LEIGH ANNE M (AMFT)
Entity Type:Individual
Prefix:
First Name:VICTORIA LEIGH ANNE
Middle Name:M
Last Name:VELA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:VELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4500 E PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3275
Mailing Address - Country:US
Mailing Address - Phone:562-427-6818
Mailing Address - Fax:
Practice Address - Street 1:4500 E PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3275
Practice Address - Country:US
Practice Address - Phone:562-427-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11421101YP2500X
CA131224106H00000X
CAAMFT131224106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional