Provider Demographics
NPI:1558905935
Name:PEREZ, EDWARD GREGORY (LPC, LMSW)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:GREGORY
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LPC, LMSW
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 340050
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-0050
Mailing Address - Country:US
Mailing Address - Phone:210-213-1342
Mailing Address - Fax:
Practice Address - Street 1:9500 TIOGA DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3118
Practice Address - Country:US
Practice Address - Phone:210-616-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional