Provider Demographics
NPI:1881829141
Name:VELEZ, JIM W (MS MA LPC)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:W
Last Name:VELEZ
Suffix:
Gender:M
Credentials:MS MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23759 SE BONNIE LURE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97022-9692
Mailing Address - Country:US
Mailing Address - Phone:503-467-9948
Mailing Address - Fax:
Practice Address - Street 1:8305 SE MONTEREY AVE
Practice Address - Street 2:SUITE #220
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97086-7725
Practice Address - Country:US
Practice Address - Phone:503-658-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC-#1240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional