Provider Demographics
NPI:1437414067
Name:VELASCO, IRENE (LMFT)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:VELASCO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BELLEFONTAINE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3132
Mailing Address - Country:US
Mailing Address - Phone:855-501-1004
Mailing Address - Fax:626-689-4851
Practice Address - Street 1:50 BELLEFONTAINE ST STE 205
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3132
Practice Address - Country:US
Practice Address - Phone:855-501-1004
Practice Address - Fax:626-689-4851
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75320101YM0800X
CA110325106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health