Healthcare Provider Details

I. General information

NPI: 1083772081
Provider Name (Legal Business Name): DEBRA M PEREZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 SAN MATEO BLVD NE STE W4
ALBUQUERQUE NM
87110-4070
US

IV. Provider business mailing address

12420 TULAROSA TRL NE
ALBUQUERQUE NM
87111-7275
US

V. Phone/Fax

Practice location:
  • Phone: 505-975-1309
  • Fax:
Mailing address:
  • Phone: 505-975-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0105241
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: