Provider Demographics
NPI:1588145882
Name:VELASCO MIRANDA, EURIDICE BERENICE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:EURIDICE
Middle Name:BERENICE
Last Name:VELASCO MIRANDA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:EURIDICE
Other - Middle Name:
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:5740 RALSTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5740 RALSTON ST STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7847
Practice Address - Country:US
Practice Address - Phone:805-236-7556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA123086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist