Provider Demographics
NPI:1386161271
Name:PEREZ, SYDNEY (LMHC)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:PEREZ
Other - Last Name:HUNTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 GANDY BLVD N.
Mailing Address - Street 2:PO BOX 20694
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702
Mailing Address - Country:US
Mailing Address - Phone:305-333-9872
Mailing Address - Fax:
Practice Address - Street 1:905 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1033
Practice Address - Country:US
Practice Address - Phone:863-450-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health