Healthcare Provider Details

I. General information

NPI: 1437414067
Provider Name (Legal Business Name): IRENE VELASCO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BELLEFONTAINE ST STE 205
PASADENA CA
91105-3132
US

IV. Provider business mailing address

50 BELLEFONTAINE ST STE 205
PASADENA CA
91105-3132
US

V. Phone/Fax

Practice location:
  • Phone: 855-501-1004
  • Fax: 626-689-4851
Mailing address:
  • Phone: 855-501-1004
  • Fax: 626-689-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number75320
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number110325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: