Healthcare Provider Details

I. General information

NPI: 1013321090
Provider Name (Legal Business Name): KIMM MARIE PEREZ PHD, LPA, LPC- S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11971 N GRAND PKWY E STE 200
NEW CANEY TX
77357-1828
US

IV. Provider business mailing address

11971 N GRAND PKWY E STE 200 #207
NEW CANEY TX
77357-1827
US

V. Phone/Fax

Practice location:
  • Phone: 346-471-5200
  • Fax: 346-474-0990
Mailing address:
  • Phone: 346-471-5200
  • Fax: 346-474-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number64721
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number64721
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64721
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number39232
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: