Provider Demographics
NPI:1598304727
Name:VELEZ, GRISSELLE IVETTE (MC)
Entity Type:Individual
Prefix:PROF
First Name:GRISSELLE
Middle Name:IVETTE
Last Name:VELEZ
Suffix:
Gender:F
Credentials:MC
Other - Prefix:MS
Other - First Name:GRISSELLE
Other - Middle Name:IVETTE
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SIMPSON
Mailing Address - Street 1:91ST PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 N BULLARD AVE APT 1095
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-3339
Practice Address - Country:US
Practice Address - Phone:352-678-8554
Practice Address - Fax:352-678-8554
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor