MEDICARE: CELIA PEREZ ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	19227	CA

General Provider Information

NPI Number	:	1033447321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELIA PEREZ ACSW

Provider Business Mailing Address
First Line	:	370 9TH ST
Second Line	:
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-3432
Country	:	US
Telephone Number	:	707-460-6391
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 9TH ST
Second Line	:
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-3430
Country	:	US
Telephone Number	:	707-460-6391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	01/23/2019

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