Provider Demographics
NPI:1083772081
Name:PEREZ, DEBRA M (LMHC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12420 TULAROSA TRL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7275
Mailing Address - Country:US
Mailing Address - Phone:505-975-1309
Mailing Address - Fax:
Practice Address - Street 1:2403 SAN MATEO BLVD NE STE W4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4070
Practice Address - Country:US
Practice Address - Phone:505-975-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0105241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional