Provider Demographics
NPI:1790573822
Name:PERGESON, AMBER LYNNE (PPS)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNNE
Last Name:PERGESON
Suffix:
Gender:
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N JUANITA AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3686
Mailing Address - Country:US
Mailing Address - Phone:805-385-1536
Mailing Address - Fax:805-981-1754
Practice Address - Street 1:701 N JUANITA AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3686
Practice Address - Country:US
Practice Address - Phone:805-385-1536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210348038101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool