MEDICARE: MRS. ROSARIO VELAZQUEZ I LMHC

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
1	101YM0800X	Mental Health Counselor	0126331	NM

General Provider Information

NPI Number	:	1932423597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSARIO VELAZQUEZ I LMHC

Provider Business Mailing Address
First Line	:	1129 SUN SHADOW DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-7640
Country	:	US
Telephone Number	:	915-585-8322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1129 SUN SHADOW DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-7640
Country	:	US
Telephone Number	:	915-585-8322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	03/24/2010

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