Provider Demographics
NPI:1568064582
Name:PEREZ, STACY LEE
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LEE
Last Name: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 1:8950 CAL CENTER DR STE 340
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3225
Mailing Address - Country:US
Mailing Address - Phone:916-254-5200
Mailing Address - Fax:
Practice Address - Street 1:8950 CAL CENTER DR STE 340
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3225
Practice Address - Country:US
Practice Address - Phone:916-254-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health