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NPI Code Detail

MEDICARE: BLANCA ITZEL VELA LPC-S

MEDICARE: BLANCA ITZEL VELA LPC-S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor72060TX

General Provider Information

NPI Number : 1013364611
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLANCA ITZEL VELA LPC-S
Provider Business Mailing Address
First Line : 15144 ORPHEUS WAY
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78245-3901
Country : US
Telephone Number : 210-363-7108
Fax Number :
Provider Business Practice Location Address
First Line : 1950 EPHRIHAM AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76164-6670
Country : US
Telephone Number : 817-813-7075
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2016
Last Update Date : 10/24/2024

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Directions to “ BLANCA ITZEL VELA LPC-S” Practice Location

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