Provider Demographics
NPI:1760651442
Name:PEREZ, TIMOTHY ALLEN (RN, MN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:PEREZ
Suffix:
Gender:M
Credentials:RN, MN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 SW VARNS ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8173
Mailing Address - Country:US
Mailing Address - Phone:503-389-1500
Mailing Address - Fax:800-974-5025
Practice Address - Street 1:7105 SW VARNS ST
Practice Address - Street 2:SUITE 270
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8173
Practice Address - Country:US
Practice Address - Phone:503-389-1500
Practice Address - Fax:800-974-5025
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950089NP363LP0808X, 363LP0808X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health