Individual
MR. ROBERTO PEREZ JACQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
515 E. LARA ROAD, CHAMBERINO, NM 88027-0307
(505) 644-2452
Mailing address
PO BOX 307, CHAMBERINO, NM 88027-0307
(505) 644-2452
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
006091
NM
Other
Enumeration date
06/27/2007
Last updated
07/08/2007
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