Provider Demographics
NPI:1285417022
Name:MARTINEZ VELA, GRACIELA (MA, LPC, LCDC, NCC)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:MARTINEZ VELA
Suffix:
Gender:F
Credentials:MA, LPC, LCDC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 SERENO
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-5203
Mailing Address - Country:US
Mailing Address - Phone:956-220-7002
Mailing Address - Fax:
Practice Address - Street 1:1319 CORPUS CHRISTI ST STE 4
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5321
Practice Address - Country:US
Practice Address - Phone:956-220-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10008101YA0400X
TX83603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)