Provider Demographics
NPI:1114090354
Name:PEREZ, AMBER D (LADC 693)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:D
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LADC 693
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:D
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:721 K ST
Mailing Address - Street 2:THE BRIDGE AT CORNHUSKER PLACE
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2949
Mailing Address - Country:US
Mailing Address - Phone:402-477-3951
Mailing Address - Fax:402-477-9117
Practice Address - Street 1:721 K ST
Practice Address - Street 2:THE BRIDGE AT CORNHUSKER PLACE
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2949
Practice Address - Country:US
Practice Address - Phone:402-477-3951
Practice Address - Fax:402-477-9117
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47057655277Medicaid
NE47057655277Medicaid