Provider Demographics
NPI:1932479128
Name:PEREZ DE JESUS, JOSELINE (MHA)
Entity Type:Individual
Prefix:MS
First Name:JOSELINE
Middle Name:
Last Name:PEREZ DE JESUS
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10659 SPRUCE VIEW LOOP
Mailing Address - Street 2:APARTMENT 124
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4543
Mailing Address - Country:US
Mailing Address - Phone:907-947-5031
Mailing Address - Fax:
Practice Address - Street 1:4020 FOLKER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5321
Practice Address - Country:US
Practice Address - Phone:907-762-8671
Practice Address - Fax:907-743-3033
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health