Provider Demographics
NPI:1255179875
Name:PEREZ, CIERA NICOLE (AMFT)
Entity type:Individual
Prefix:
First Name:CIERA
Middle Name:NICOLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 YATES DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4705
Mailing Address - Country:US
Mailing Address - Phone:707-494-6194
Mailing Address - Fax:
Practice Address - Street 1:1023 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4301
Practice Address - Country:US
Practice Address - Phone:707-569-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist