Provider Demographics
NPI:1326372681
Name:PEREZ, CHANDRA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CHANDRA
Other - Middle Name:L
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2110 OVERLAND AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6440
Mailing Address - Country:US
Mailing Address - Phone:406-655-2136
Mailing Address - Fax:406-652-8997
Practice Address - Street 1:101 E BROADWAY STE 400
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3104
Practice Address - Country:US
Practice Address - Phone:541-357-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MT2180101YP2500X
MT1047103T00000X
OR3722103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1326372681Medicaid