MEDICARE: SERGIO PEREZ

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	101YP2500X	Professional Counselor	99535	TX
2	101YM0800X	Mental Health Counselor	99535	TX

General Provider Information

NPI Number	:	1740142777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO PEREZ

Provider Business Mailing Address
First Line	:	PO BOX 114
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-0043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 114
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-0043
Country	:	US
Telephone Number	:	972-559-4843
Fax Number	:

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

Provider Enumeration Date	:	11/28/2025
Last Update Date	:	12/02/2025

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Directions to “ SERGIO PEREZ ” Practice Location

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