Provider Demographics
NPI:1518791540
Name:PEREZ, LUIS FERNANDO (LAC)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:FERNANDO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-8269
Mailing Address - Country:US
Mailing Address - Phone:520-686-1689
Mailing Address - Fax:
Practice Address - Street 1:174 S CORONADO DR STE B
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6356
Practice Address - Country:US
Practice Address - Phone:520-770-9745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health