Provider Demographics
NPI:1326846932
Name:JAIMES PEREZ, LUCELENE
Entity type:Individual
Prefix:
First Name:LUCELENE
Middle Name:
Last Name:JAIMES PEREZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 MORAGA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6114
Mailing Address - Country:US
Mailing Address - Phone:707-545-4283
Mailing Address - Fax:
Practice Address - Street 1:2121 MORAGA DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6114
Practice Address - Country:US
Practice Address - Phone:707-545-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210128577101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool