Provider Demographics
NPI:1689363657
Name:VELIZ, SELIA MARISA
Entity Type:Individual
Prefix:
First Name:SELIA
Middle Name:MARISA
Last Name:VELIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N ARNEY RD STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-8462
Mailing Address - Country:US
Mailing Address - Phone:503-395-4224
Mailing Address - Fax:
Practice Address - Street 1:255 N ARNEY RD STE 220
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-8462
Practice Address - Country:US
Practice Address - Phone:503-395-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA139921041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health