Provider Demographics
NPI:1134556160
Name:PEREZ, HAILEY MICHELLE HOLLERS (MA, LMFT)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:MICHELLE HOLLERS
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6186
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92816-0186
Mailing Address - Country:US
Mailing Address - Phone:909-851-8028
Mailing Address - Fax:
Practice Address - Street 1:625 MARKET ST FL 15
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-3316
Practice Address - Country:US
Practice Address - Phone:415-360-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
CA115373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA115373OtherLMFT