Healthcare Provider Details

I. General information

NPI: 1669906616
Provider Name (Legal Business Name): AVERY PEREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 234
LA VERNE CA
91750-0234
US

IV. Provider business mailing address

PO BOX 234
LA VERNE CA
91750-0234
US

V. Phone/Fax

Practice location:
  • Phone: 626-671-5356
  • Fax:
Mailing address:
  • Phone: 626-671-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT127043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: