Healthcare Provider Details

I. General information

NPI: 1952651408
Provider Name (Legal Business Name): VALERIE PEREZ PSYD/ HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CUMBERLAND XING STE 108
VALPARAISO IN
46383-2356
US

IV. Provider business mailing address

10208 S INDIANAPOLIS AVE STE 301
CHICAGO IL
60617-6033
US

V. Phone/Fax

Practice location:
  • Phone: 866-413-1988
  • Fax: 866-628-8599
Mailing address:
  • Phone: 866-413-1988
  • Fax: 866-628-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071009045
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042756A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: