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General NPI Number Information
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NPI Number | 1013159318
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Entity Type | Individual
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Provider Name | MARTIN ALEX PEREA LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 628 N VERMONT AVE STE 10
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City | LOS ANGELES
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State | CA
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Zip | 90004
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Country | US
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Telephone | 323-252-5358
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Fax |
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Provider Business Mailing Address
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Address Line | 628 N VERMONT AVE STE 10
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City | LOS ANGELES
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State | CA
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Zip | 90004-2154
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Country | US
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Telephone | 323-252-5358
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 46284
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC46284
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License Number State | CA
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