Healthcare Provider Details

I. General information

NPI: 1851221410
Provider Name (Legal Business Name): COLLEEN TEMAJ PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 STONE CREEK VALLEY DR
O FALLON MO
63366-5420
US

IV. Provider business mailing address

226 STONE CREEK VALLEY DR
O FALLON MO
63366-5420
US

V. Phone/Fax

Practice location:
  • Phone: 636-777-0781
  • Fax:
Mailing address:
  • Phone: 636-493-4716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: