Individual
MAYRA VELASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5601 STATE ST, EAST SAINT LOUIS, IL 62203-1346
(618) 213-3170
(618) 213-3171
Mailing address
5601 STATE STREET, E. ST. LOUIS, IL 62203-0204
(618) 213-3170
(618) 213-3171
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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