Healthcare Provider Details

I. General information

NPI: 1871061549
Provider Name (Legal Business Name): ALEJANDRA PEREA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2018
Last Update Date: 11/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 4TH ST NW
LOS RANCHOS NM
87107-6144
US

IV. Provider business mailing address

PO BOX 95602
ALBUQUERQUE NM
87199-5602
US

V. Phone/Fax

Practice location:
  • Phone: 505-200-9855
  • Fax: 505-214-5614
Mailing address:
  • Phone: 505-200-9855
  • Fax: 505-214-5614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0191541
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: