Provider Demographics
NPI:1528460508
Name:VELASCO, CARLOS R (LPCC)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:VELASCO
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4340
Mailing Address - Country:US
Mailing Address - Phone:909-667-0382
Mailing Address - Fax:
Practice Address - Street 1:16600 SHERMAN WAY STE 280
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3785
Practice Address - Country:US
Practice Address - Phone:909-667-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-21
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5800101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALPCC5800OtherBOARD OF BEHAVIOR SCIENCES