MEDICARE: CAMILLE D PEREZ LMHC

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	MH 10045	FL

General Provider Information

NPI Number	:	1649580580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE D PEREZ LMHC

Provider Business Mailing Address
First Line	:	523 HICKORY CT
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-1438
Country	:	US
Telephone Number	:	305-510-7940
Fax Number	:	407-737-7997

Provider Business Practice Location Address
First Line	:	630 N SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3330
Country	:	US
Telephone Number	:	407-737-4007
Fax Number	:	407-737-7997

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

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	02/17/2014

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