1437731601 NPI number — PERRY COUNSELING SERVICES, LLC

Table of content: (NPI 1437731601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437731601 NPI number — PERRY COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERRY COUNSELING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1437731601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 IVERN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRAL POINT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97502-3621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-699-1104
Provider Business Mailing Address Fax Number:
541-423-5313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 E MAIN ST STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97501-6022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-699-1104
Provider Business Practice Location Address Fax Number:
541-499-0271
Provider Enumeration Date:
04/26/2021

Additional Information

Authorized Official

Authorized Official Last Name:
PERRY
Authorized Official First Name:
ALMYRA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER & COUNSELOR
Authorized Official Telephone Number:
405-699-1104

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500717535 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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