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General NPI Number Information
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NPI Number | 1164525580
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Entity Type | Individual
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Provider Name | MARK ANTHONY VELLUCCI MA
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 11818 SE MILL PLAIN BLVD SUITE 311C
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City | VANCOUVER
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State | WA
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Zip | 99684
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Country | US
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Telephone | 360-571-3981
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Fax | 503-578-2454
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Provider Business Mailing Address
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Address Line | 11818 SE MILL PLAIN BLVD STE 311C
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City | VANCOUVER
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State | WA
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Zip | 98684-5091
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Country | US
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Telephone | 360-571-3981
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Fax | 503-578-2454
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH00004640
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License Number State | WA
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