Provider Demographics
NPI:1609350875
Name:VELO, KAYLEE RENE
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:RENE
Last Name:VELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:RENE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4631 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-1633
Mailing Address - Country:US
Mailing Address - Phone:559-707-3822
Mailing Address - Fax:
Practice Address - Street 1:4631 N 2ND ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-1633
Practice Address - Country:US
Practice Address - Phone:559-707-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93905101YM0800X
CA1188451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health