Healthcare Provider Details

I. General information

NPI: 1942753025
Provider Name (Legal Business Name): COURTNEY LEE PEREZ MA IN EDUCATION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY LEE GLOVER

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 FOLSOM BLVD STE 265
SACRAMENTO CA
95826-3250
US

IV. Provider business mailing address

5738 WINDMILL WAY APT 36
CARMICHAEL CA
95608-1383
US

V. Phone/Fax

Practice location:
  • Phone: 916-382-4447
  • Fax:
Mailing address:
  • Phone: 916-600-3705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: