Healthcare Provider Details

I. General information

NPI: 1194455592
Provider Name (Legal Business Name): CATALINA PERILLA-SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 NE 65TH ST STE A
VANCOUVER WA
98662-5527
US

IV. Provider business mailing address

6811 NE 121ST AVE APT X211
VANCOUVER WA
98682-5579
US

V. Phone/Fax

Practice location:
  • Phone: 360-558-5790
  • Fax:
Mailing address:
  • Phone: 564-208-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: