Healthcare Provider Details

I. General information

NPI: 1528460508
Provider Name (Legal Business Name): CARLOS R VELASCO LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2014
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W BROADWAY STE 155
GLENDALE CA
91204-1332
US

IV. Provider business mailing address

PO BOX 291083
LOS ANGELES CA
90029-9083
US

V. Phone/Fax

Practice location:
  • Phone: 818-441-7800
  • Fax:
Mailing address:
  • Phone: 424-309-2641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5800
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: