Provider Demographics
NPI:1780253377
Name:PEREZ, MARIAH CATHERINE
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:CATHERINE
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 1:12601 BLACK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1010
Mailing Address - Country:US
Mailing Address - Phone:512-608-3603
Mailing Address - Fax:
Practice Address - Street 1:700 N SAINT MARYS ST STE 1400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-3535
Practice Address - Country:US
Practice Address - Phone:847-465-9556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40807267103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst