MEDICARE: ALEJANDRA PEREA 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	0191541	NM

General Provider Information

NPI Number	:	1871061549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRA PEREA LMHC

Provider Business Mailing Address
First Line	:	PO BOX 95602
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87199-5602
Country	:	US
Telephone Number	:	505-200-9855
Fax Number	:	505-214-5614

Provider Business Practice Location Address
First Line	:	6666 4TH ST NW
Second Line	:
City	:	LOS RANCHOS
State	:	NM
Zip	:	87107-6144
Country	:	US
Telephone Number	:	505-200-9855
Fax Number	:	505-214-5614

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

Provider Enumeration Date	:	11/11/2018
Last Update Date	:	11/11/2018

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