Basic Information
Provider Information | |||||||||
NPI: | 1326558453 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STAPLES-FOSTER | ||||||||
FirstName: | VELMA | ||||||||
MiddleName: | GWENDOLYN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MA, LMFT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 24355 CREEKSIDE RD UNIT 800616 | ||||||||
Address2: |   | ||||||||
City: | SANTA CLARITA | ||||||||
State: | CA | ||||||||
PostalCode: | 913807048 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6263469481 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 25050 AVENUE KEARNY STE 215 | ||||||||
Address2: |   | ||||||||
City: | VALENCIA | ||||||||
State: | CA | ||||||||
PostalCode: | 913551257 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3238799176 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/03/2017 | ||||||||
LastUpdateDate: | 09/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/03/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | AMFT109963 | CA | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP1600X |   |   | N |   | Behavioral Health & Social Service Providers | Counselor | Pastoral | 106H00000X | 127905 | CA | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.