Provider Demographics
NPI:1164872982
Name:PEREZ, MARIBEL (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2161
Mailing Address - Street 2:
Mailing Address - City:IRWINDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91706-1105
Mailing Address - Country:US
Mailing Address - Phone:626-386-9182
Mailing Address - Fax:626-722-4419
Practice Address - Street 1:855 N LARK ELLEN AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1099
Practice Address - Country:US
Practice Address - Phone:626-386-9182
Practice Address - Fax:626-722-4419
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF85623101YM0800X
CAPCCI1948101YM0800X
CALPCC8257101YP2500X
CA115458106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional