Provider Demographics
NPI:1831697507
Name:PEREZ, ANSTISS MARIE (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:ANSTISS
Middle Name:MARIE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:ANSTISS
Other - Middle Name:MARIE
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1442 E NORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5717
Mailing Address - Country:US
Mailing Address - Phone:949-702-0020
Mailing Address - Fax:
Practice Address - Street 1:841 S SUNKIST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4716
Practice Address - Country:US
Practice Address - Phone:657-200-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC13733101Y00000X
CAAMFT139198106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPCC13733OtherBOARD OF BEHAVIORAL SCIENCES
CAAMFT139198OtherBOARD OF BEHAVIORAL SCIENCES