Provider Demographics
NPI:1679072193
Name:VELAZQUEZ, ROGELIO MANUEL (LPC)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:MANUEL
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 N COCKRELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2717
Mailing Address - Country:US
Mailing Address - Phone:469-867-0093
Mailing Address - Fax:469-867-0093
Practice Address - Street 1:1007 N COCKRELL HILL RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2717
Practice Address - Country:US
Practice Address - Phone:469-867-0093
Practice Address - Fax:469-867-0093
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional