Provider Demographics
NPI:1831686377
Name:PERRY, CHRISTINE VICTORIA (LMFT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:VICTORIA
Last Name:PERRY
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 1:327 E SAN EMIDIO ST
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-3011
Mailing Address - Country:US
Mailing Address - Phone:661-770-7129
Mailing Address - Fax:
Practice Address - Street 1:327 E SAN EMIDIO ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-3011
Practice Address - Country:US
Practice Address - Phone:661-770-7129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97952101YM0800X
CA115985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health