Provider Demographics
NPI:1861626137
Name:PEREZ, CLAUDIA JEAN
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:JEAN
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 1:2821 MISSION HILL RD
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-9706
Mailing Address - Country:US
Mailing Address - Phone:360-716-4400
Mailing Address - Fax:360-651-4404
Practice Address - Street 1:2821 MISSION HILL ROAD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-9706
Practice Address - Country:US
Practice Address - Phone:360-716-4400
Practice Address - Fax:360-651-4404
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006238101YA0400X
WARC00052495101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)