Provider Demographics
NPI:1922660570
Name:JEREZ, CIARA RENEE (LMFT CANDIDATE)
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:RENEE
Last Name:JEREZ
Suffix:
Gender:F
Credentials:LMFT CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 SW WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-7231
Mailing Address - Country:US
Mailing Address - Phone:580-699-7654
Mailing Address - Fax:
Practice Address - Street 1:1317 SW WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-7231
Practice Address - Country:US
Practice Address - Phone:580-699-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist