Provider Demographics
NPI:1073154282
Name:VEA GASTELUM, PERLA
Entity Type:Individual
Prefix:
First Name:PERLA
Middle Name:
Last Name:VEA GASTELUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PERLA
Other - Middle Name:SUJEY
Other - Last Name:VEA FIERRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-1408
Mailing Address - Country:US
Mailing Address - Phone:760-709-0896
Mailing Address - Fax:
Practice Address - Street 1:1360 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3013
Practice Address - Country:US
Practice Address - Phone:760-873-6533
Practice Address - Fax:760-873-3277
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA138024101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor