Basic Information
| Provider Information | |||||||||
| NPI: | 1437133303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELIZ | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 WEEOT WAY | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955214734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078255060 | ||||||||
| FaxNumber: | 7078256753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 WEEOT WAY | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955214734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078255060 | ||||||||
| FaxNumber: | 7078256753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 18235 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.