Provider Demographics
NPI:1487116505
Name:PEREZ, MARIA SOLEDAD (LCDC)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:SOLEDAD
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCDC
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 1125
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-1125
Mailing Address - Country:US
Mailing Address - Phone:210-939-5627
Mailing Address - Fax:
Practice Address - Street 1:110A DUSTINS DR
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5026
Practice Address - Country:US
Practice Address - Phone:210-939-5627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-06
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14278101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)