Provider Demographics
NPI:1205000635
Name:PEREZ-REDE, SOLANJA (LPC)
Entity Type:Individual
Prefix:
First Name:SOLANJA
Middle Name:
Last Name:PEREZ-REDE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E CASTELLANO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6435
Mailing Address - Country:US
Mailing Address - Phone:915-861-9056
Mailing Address - Fax:877-587-9452
Practice Address - Street 1:105 E CASTELLANO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6435
Practice Address - Country:US
Practice Address - Phone:915-861-9056
Practice Address - Fax:877-587-9452
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198783605Medicaid