Healthcare Provider Details

I. General information

NPI: 1225531627
Provider Name (Legal Business Name): VELEZ CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 CAMINO DE LOS CABALLOS
GALLUP NM
87301-6892
US

IV. Provider business mailing address

3506 CAMINO DE LOS CABALLOS
GALLUP NM
87301-6892
US

V. Phone/Fax

Practice location:
  • Phone: 505-862-3109
  • Fax:
Mailing address:
  • Phone: 505-862-3109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMBER NICOLE VELEZ
Title or Position: INDEPENT CASE MANAGER
Credential: CSW
Phone: 505-862-3109