Provider Demographics
NPI:1326558453
Name:STAPLES, VELMA GWENDOLYN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:VELMA
Middle Name:GWENDOLYN
Last Name:STAPLES
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14028 VAN NESS AVE UNIT 1013
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-6200
Mailing Address - Country:US
Mailing Address - Phone:626-346-9481
Mailing Address - Fax:
Practice Address - Street 1:2593 GRIFFITH CT
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-1663
Practice Address - Country:US
Practice Address - Phone:626-346-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT109963101YM0800X
101YP1600X
CA127905106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral