1235296856 NPI number — MISS VIEMA CHINWE EMMANUEL-PEREZ LPC, LCDC-I

Table of content: MISS VIEMA CHINWE EMMANUEL-PEREZ LPC, LCDC-I (NPI 1235296856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235296856 NPI number — MISS VIEMA CHINWE EMMANUEL-PEREZ LPC, LCDC-I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMMANUEL-PEREZ
Provider First Name:
VIEMA
Provider Middle Name:
CHINWE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LPC, LCDC-I
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235296856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
581 MAJESTIC PARK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR HILL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75104-1763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-448-1436
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3603 W PIONEER PKWY STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PANTEGO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76013-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-801-3414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  62485 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 348960101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 348960102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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