Provider Demographics
NPI:1700356078
Name:PEREZ, LYDIA KAY (LICSWA)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:KAY
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LICSWA
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:KAY
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:7522 S PALOUSE HWY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-2016
Mailing Address - Country:US
Mailing Address - Phone:509-761-9415
Mailing Address - Fax:
Practice Address - Street 1:721 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5225
Practice Address - Country:US
Practice Address - Phone:509-892-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC615892181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical