Provider Demographics
NPI:1750147138
Name:VELEZ, ANGELA (MSMHC, RMHCI)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:VELEZ
Suffix:
Gender:F
Credentials:MSMHC, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1711
Mailing Address - Country:US
Mailing Address - Phone:239-371-6206
Mailing Address - Fax:
Practice Address - Street 1:1361 ROYAL PALM SQUARE BLVD STE 7
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1001
Practice Address - Country:US
Practice Address - Phone:941-677-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty