MEDICARE: ANGELA VELASCO MA, LMHC, MHP, CDP-T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	60814778	WA
2	101YM0800X	Mental Health Counselor	60338531	WA

General Provider Information

NPI Number	:	1386150654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA VELASCO MA, LMHC, MHP, CDP-T

Provider Business Mailing Address
First Line	:	PO BOX 2253
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99210-2253
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 W FORT GEORGE WRIGHT DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5202
Country	:	US
Telephone Number	:	509-455-4977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	12/21/2017

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