Provider Demographics
NPI:1669597621
Name:VELASQUEZ, TERRIE LYNN (MFT)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:LYNN
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4773 CAUGHLIN PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-1011
Mailing Address - Country:US
Mailing Address - Phone:775-677-2216
Mailing Address - Fax:775-322-4460
Practice Address - Street 1:4773 CAUGHLIN PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-1011
Practice Address - Country:US
Practice Address - Phone:775-677-2216
Practice Address - Fax:775-322-4460
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV700106H00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510431Medicaid