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General NPI Number Information
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NPI Number | 1649771692
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Entity Type | Individual
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Provider Name | AMANDA MARIE VELEZ MSSW
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Gender | Female
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 912 LILY CREEK RD
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City | LOUISVILLE
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State | KY
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Zip | 40243
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Country | US
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Telephone | 502-338-0608
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Fax |
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Provider Business Mailing Address
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Address Line | 4301 CLOVERLEAF DR
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City | LOUISVILLE
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State | KY
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Zip | 40216-3903
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Country | US
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Telephone | 270-317-5664
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 173716
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License Number State | KY
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