Provider Demographics
NPI:1508403320
Name:PEREZ, JUAN DAVID JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:DAVID
Last Name:PEREZ
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 OPORTO PATH
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-1335
Mailing Address - Country:US
Mailing Address - Phone:281-610-1990
Mailing Address - Fax:
Practice Address - Street 1:526 OPORTO PATH
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-1335
Practice Address - Country:US
Practice Address - Phone:281-610-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77381101YA0400X, 171M00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator