Provider Demographics
NPI:1770074841
Name:CORDOVA-VELAYO, CHARINA GASTON (LMFT)
Entity type:Individual
Prefix:
First Name:CHARINA
Middle Name:GASTON
Last Name:CORDOVA-VELAYO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 30TH ST APT D5-12
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1753
Mailing Address - Country:US
Mailing Address - Phone:303-875-7803
Mailing Address - Fax:
Practice Address - Street 1:119 UCB
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-5001
Practice Address - Country:US
Practice Address - Phone:303-492-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0000728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist