Provider Demographics
NPI:1467070276
Name:PEREZ, KEYANA FAITH (LMSW)
Entity Type:Individual
Prefix:
First Name:KEYANA
Middle Name:FAITH
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W WILLIAMS ST STE G
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3564
Mailing Address - Country:US
Mailing Address - Phone:208-991-0222
Mailing Address - Fax:
Practice Address - Street 1:1011 W WILLIAMS ST STE G
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3564
Practice Address - Country:US
Practice Address - Phone:208-991-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID39723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health