Healthcare Provider Details

I. General information

NPI: 1154652634
Provider Name (Legal Business Name): JOHN GABRIEL PEREZ LPCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 32ND AVE S STE 210
FARGO ND
58103-6163
US

IV. Provider business mailing address

3003 32ND AVE S STE 210
FARGO ND
58103-6163
US

V. Phone/Fax

Practice location:
  • Phone: 701-541-0313
  • Fax: 701-291-2021
Mailing address:
  • Phone: 701-541-0313
  • Fax: 701-291-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC01903
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number666-9-1-10-243
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number666-9-1-10-243
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCC01903
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: