Provider Demographics
NPI:1922413244
Name:VELASQUEZ, THOMAS FRANK SR (RT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:FRANK
Last Name:VELASQUEZ
Suffix:SR
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 CARMALITA AVE.
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422
Mailing Address - Country:US
Mailing Address - Phone:805-466-2762
Mailing Address - Fax:
Practice Address - Street 1:2178 JOHNSON AVE.
Practice Address - Street 2:
Practice Address - City:S.L.O
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-781-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor