Healthcare Provider Details

I. General information

NPI: 1700617883
Provider Name (Legal Business Name): RUTH PEREZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5476 E ATLANTIC PL
DENVER CO
80222-4714
US

IV. Provider business mailing address

5476 E ATLANTIC PL
DENVER CO
80222-4714
US

V. Phone/Fax

Practice location:
  • Phone: 305-335-1661
  • Fax:
Mailing address:
  • Phone: 305-335-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0020813
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: