Provider Demographics
NPI:1659719953
Name:STOCK, VETA IRENE (LMFT, CO#1072)
Entity Type:Individual
Prefix:MS
First Name:VETA
Middle Name:IRENE
Last Name:STOCK
Suffix:
Gender:F
Credentials:LMFT, CO#1072
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14625 BERMUDA DUNES WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921
Mailing Address - Country:US
Mailing Address - Phone:719-304-9207
Mailing Address - Fax:719-481-1428
Practice Address - Street 1:14625 BERMUDA DUNES WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921
Practice Address - Country:US
Practice Address - Phone:719-304-9207
Practice Address - Fax:719-481-1428
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35687106H00000X
CO1072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist