Healthcare Provider Details

I. General information

NPI: 1952050510
Provider Name (Legal Business Name): PEDRO BOTERO VELEZ LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9423 18TH AVE W UNIT A
EVERETT WA
98204-1427
US

IV. Provider business mailing address

9423 18TH AVE W UNIT A
EVERETT WA
98204-1427
US

V. Phone/Fax

Practice location:
  • Phone: 425-610-6506
  • Fax:
Mailing address:
  • Phone: 425-610-6506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61556737
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG61255547
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMC61439464
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: