Provider Demographics
NPI:1538681259
Name:PEREZ, SHAELENE JEANAE
Entity Type:Individual
Prefix:
First Name:SHAELENE
Middle Name:JEANAE
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 1:5910 WEBB BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3754
Mailing Address - Country:US
Mailing Address - Phone:808-780-0014
Mailing Address - Fax:
Practice Address - Street 1:1155 HEMBREE RD STE 210
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4635
Practice Address - Country:US
Practice Address - Phone:808-222-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-17-34297106S00000X
WA1-20-43164103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician