Provider Demographics
NPI:1134290315
Name:PEREZ, ANA M (MFT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 GREENWORTH PL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2503
Mailing Address - Country:US
Mailing Address - Phone:805-284-4330
Mailing Address - Fax:
Practice Address - Street 1:629 STATE ST
Practice Address - Street 2:SUITE 203C
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-7069
Practice Address - Country:US
Practice Address - Phone:805-284-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50619106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2992Medicare ID - Type Unspecified