Provider Demographics
NPI:1396998712
Name:VELASCO, MARY ANN (LMHC)
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:VELASCO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2175
Mailing Address - Country:US
Mailing Address - Phone:425-282-0333
Mailing Address - Fax:425-235-7422
Practice Address - Street 1:200 MILL AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2175
Practice Address - Country:US
Practice Address - Phone:425-282-0333
Practice Address - Fax:425-235-7422
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health