Provider Demographics
NPI:1437417821
Name:PEREZ, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 N GRAND ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2700
Mailing Address - Country:US
Mailing Address - Phone:620-704-5143
Mailing Address - Fax:
Practice Address - Street 1:613 N BROADWAY ST
Practice Address - Street 2:SUITE C
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-3957
Practice Address - Country:US
Practice Address - Phone:620-704-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health