Provider Demographics
NPI:1013364611
Name:VELA, BLANCA ITZEL (LPC-S)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:ITZEL
Last Name:VELA
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:ITZEL
Other - Last Name:FAVELA MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:15144 ORPHEUS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3901
Mailing Address - Country:US
Mailing Address - Phone:210-363-7108
Mailing Address - Fax:
Practice Address - Street 1:1950 EPHRIHAM AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-6670
Practice Address - Country:US
Practice Address - Phone:817-813-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional