=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477133981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. FAITH ANNE PEREZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2021
-----------------------------------------------------
Last Update Date | 04/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 645 N WALNUT AVE
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78130-7925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-730-6090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8815 SPANISH MOSS
-----------------------------------------------------
City | WINDCREST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78239-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-998-9352
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 81516
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------