Provider Demographics
NPI:1790169175
Name:VELAZCO GUTIERREZ, LUDIVINA ALEJANDRA (MED)
Entity Type:Individual
Prefix:
First Name:LUDIVINA
Middle Name:ALEJANDRA
Last Name:VELAZCO GUTIERREZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 REGENCY SQUARE BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3138
Mailing Address - Country:US
Mailing Address - Phone:713-780-2833
Mailing Address - Fax:
Practice Address - Street 1:7211 REGENCY SQUARE BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3138
Practice Address - Country:US
Practice Address - Phone:713-780-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional