Provider Demographics
NPI:1699661199
Name:PEREZ, ALYSSA ANNE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANNE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ROXANA
Mailing Address - State:IL
Mailing Address - Zip Code:62084-1313
Mailing Address - Country:US
Mailing Address - Phone:813-759-3794
Mailing Address - Fax:
Practice Address - Street 1:16A PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5853
Practice Address - Country:US
Practice Address - Phone:314-246-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health