Healthcare Provider Details

I. General information

NPI: 1962277962
Provider Name (Legal Business Name): ALYSSA PEREZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 POWELL RD
WILDWOOD FL
34785-4230
US

IV. Provider business mailing address

7330 POWELL RD
WILDWOOD FL
34785-4230
US

V. Phone/Fax

Practice location:
  • Phone: 352-352-6111
  • Fax:
Mailing address:
  • Phone: 352-352-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: