Provider Demographics
NPI:1780106286
Name:PEREZ, ANNMARIE
Entity type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 N BUCKNER BLVD STE 504
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-4861
Mailing Address - Country:US
Mailing Address - Phone:972-502-4190
Mailing Address - Fax:214-932-7587
Practice Address - Street 1:6006 REIGER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4581
Practice Address - Country:US
Practice Address - Phone:972-502-4124
Practice Address - Fax:214-932-7584
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical