Provider Demographics
NPI:1306970884
Name:PEREZ, CHRISTIAN ANTHONY (LMFT, CPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:ANTHONY
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LMFT, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 VERNON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2600
Mailing Address - Country:US
Mailing Address - Phone:800-252-7374
Mailing Address - Fax:800-252-7374
Practice Address - Street 1:401 VERNON ST
Practice Address - Street 2:SUITE B
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2600
Practice Address - Country:US
Practice Address - Phone:800-252-7374
Practice Address - Fax:800-252-7374
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist