Provider Demographics
NPI:1104076512
Name:VELEZ, NATHAN (PHD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:VELEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-2817
Mailing Address - Country:US
Mailing Address - Phone:928-524-6701
Mailing Address - Fax:928-524-3086
Practice Address - Street 1:105 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-2817
Practice Address - Country:US
Practice Address - Phone:928-524-6126
Practice Address - Fax:928-524-6090
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC12953101Y00000X
AZLASAC13129101YA0400X
AZLPC14297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)