Provider Demographics
NPI:1548231715
Name:REID, VELVALEE (MFT)
Entity Type:Individual
Prefix:DR
First Name:VELVALEE
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 TAPO ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-0467
Mailing Address - Country:US
Mailing Address - Phone:805-279-9136
Mailing Address - Fax:805-526-9593
Practice Address - Street 1:2775 TAPO ST STE 204
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-0467
Practice Address - Country:US
Practice Address - Phone:805-279-9136
Practice Address - Fax:805-526-9593
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 23143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38557Medicare UPIN