Provider Demographics
NPI:1063582237
Name:LA-NAE, PERCI V (LMSW)
Entity type:Individual
Prefix:MS
First Name:PERCI
Middle Name:V
Last Name:LA-NAE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:PEACH SPRINGS
Mailing Address - State:AZ
Mailing Address - Zip Code:86434-0190
Mailing Address - Country:US
Mailing Address - Phone:928-769-2962
Mailing Address - Fax:928-769-2919
Practice Address - Street 1:943 HUALAPAI WAY
Practice Address - Street 2:
Practice Address - City:PEACH SPRINGS
Practice Address - State:AZ
Practice Address - Zip Code:86434
Practice Address - Country:US
Practice Address - Phone:928-769-2900
Practice Address - Fax:928-769-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW11337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker