Healthcare Provider Details

I. General information

NPI: 1134556160
Provider Name (Legal Business Name): HAILEY MICHELLE HOLLERS PEREZ M.A., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MARKET ST FL 15
SAN FRANCISCO CA
94105-3316
US

IV. Provider business mailing address

PO BOX 6186
ANAHEIM CA
92816-0186
US

V. Phone/Fax

Practice location:
  • Phone: 415-360-3833
  • Fax:
Mailing address:
  • Phone: 909-851-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: