Provider Demographics
NPI:1780205732
Name:VELASCO, ECCLESIA SALINAS (BT)
Entity Type:Individual
Prefix:
First Name:ECCLESIA
Middle Name:SALINAS
Last Name:VELASCO
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 OLD BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:BRUCEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76630-3374
Mailing Address - Country:US
Mailing Address - Phone:254-227-0758
Mailing Address - Fax:
Practice Address - Street 1:225 CEDAR HILL ST STE 200
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-5900
Practice Address - Country:US
Practice Address - Phone:888-329-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician