Provider Demographics
NPI:1619368867
Name:PEREZ, TERESA (CADC, BA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CADC, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1200
Mailing Address - Country:US
Mailing Address - Phone:503-972-9544
Mailing Address - Fax:503-239-7390
Practice Address - Street 1:200 SE 7TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1200
Practice Address - Country:US
Practice Address - Phone:503-972-9544
Practice Address - Fax:503-239-7390
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06-07-38101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health