Provider Demographics
NPI:1942682794
Name:PERRAS, MPHO (LMFT)
Entity Type:Individual
Prefix:
First Name:MPHO
Middle Name:
Last Name:PERRAS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 LEWELLING BLVD STE 146
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1831
Mailing Address - Country:US
Mailing Address - Phone:510-250-3091
Mailing Address - Fax:
Practice Address - Street 1:2709 ALCATRAZ AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2705
Practice Address - Country:US
Practice Address - Phone:510-250-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-28
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist