Healthcare Provider Details

I. General information

NPI: 1689010225
Provider Name (Legal Business Name): CHARI JEAN PERCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SUNSET LN
DURANGO CO
81301-8385
US

IV. Provider business mailing address

250 SUNSET LN
DURANGO CO
81301-8385
US

V. Phone/Fax

Practice location:
  • Phone: 707-975-1330
  • Fax:
Mailing address:
  • Phone: 707-975-1330
  • Fax: 707-836-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number93495
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: