Provider Demographics
NPI:1801510391
Name:VELASCO, YASMIN LORENA (MA, APCC)
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:LORENA
Last Name:VELASCO
Suffix:
Gender:F
Credentials:MA, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1094
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90637-1094
Mailing Address - Country:US
Mailing Address - Phone:562-282-2455
Mailing Address - Fax:
Practice Address - Street 1:690 E GREEN ST STE 202
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2197
Practice Address - Country:US
Practice Address - Phone:626-314-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional