Provider Demographics
NPI:1669522090
Name:PEROVICH, MICHELLE ANNE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNE
Last Name:PEROVICH
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 1:7458 EXETER PL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8878
Mailing Address - Country:US
Mailing Address - Phone:720-473-9292
Mailing Address - Fax:
Practice Address - Street 1:6901 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1442
Practice Address - Country:US
Practice Address - Phone:720-473-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist