Healthcare Provider Details

I. General information

NPI: 1629982202
Provider Name (Legal Business Name): SYDNEY PEREZ LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 BRINKMAN RD
CARLYLE IL
62231-3425
US

IV. Provider business mailing address

10521 BRINKMAN RD
CARLYLE IL
62231-3425
US

V. Phone/Fax

Practice location:
  • Phone: 217-827-9544
  • Fax:
Mailing address:
  • Phone: 217-827-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180018564
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: