Individual
AUTUMN ELIZABETH-ROSE PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
QMHA-II
Contact information
Practice address
12360 E BURNSIDE ST, PORTLAND, OR 97233-1042
(971) 279-4800
(971) 279-2051
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
24-QMHA-I-004495
OR
101YM0800X
Mental Health Counselor
Primary
26-QMHA-II-000520
OR
Other
Enumeration date
08/20/2020
Last updated
02/18/2026
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