Provider Demographics
NPI:1427340264
Name:PEREZ-LOPEZ, NANCY JANETE (MFT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JANETE
Last Name:PEREZ-LOPEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 PLAZA DR STE 9A
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6931
Mailing Address - Country:US
Mailing Address - Phone:805-249-0003
Mailing Address - Fax:
Practice Address - Street 1:313 PLAZA DR STE 9A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6931
Practice Address - Country:US
Practice Address - Phone:805-249-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
97195106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health