Healthcare Provider Details

I. General information

NPI: 1306709407
Provider Name (Legal Business Name): STACEY PEREZ HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7351 E LOWRY BLVD STE 200
DENVER CO
80230-6083
US

IV. Provider business mailing address

7351 E LOWRY BLVD STE 200
DENVER CO
80230-6083
US

V. Phone/Fax

Practice location:
  • Phone: 877-825-8584
  • Fax:
Mailing address:
  • Phone: 877-825-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16044
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0023071
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number145423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: