Provider Demographics
NPI:1205984648
Name:VELAZQUEZ, OLGA G (BA)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:G
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:GALIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5050 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-1118
Mailing Address - Country:US
Mailing Address - Phone:219-763-1467
Mailing Address - Fax:219-757-1950
Practice Address - Street 1:3903 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-2555
Practice Address - Country:US
Practice Address - Phone:219-962-5311
Practice Address - Fax:219-757-1950
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor