1891884102 NPI number — MR. TIM A PERRY LPC MHSP MA

Table of content: TAMARA F LIGHTY (NPI 1831976786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891884102 NPI number — MR. TIM A PERRY LPC MHSP MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRY
Provider First Name:
TIM
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC MHSP MA
Provider Gender Code:
M

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:
1891884102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1167 SPRATLIN PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37615-6205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-467-3600
Provider Business Mailing Address Fax Number:
423-467-3644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 MIDWAY ST
Provider Second Line Business Practice Location Address:
BRISTOL REGIONAL COUNSELING CENTER
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-989-4500
Provider Business Practice Location Address Fax Number:
423-989-4568
Provider Enumeration Date:
10/12/2006

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: 101Y00000X , with the licence number:  LPC1447 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 1447 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 351654200 . This is a "DOL WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "THREE RIVERS PROVI GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "HIGHLANDS WELLMONT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "INITIAL GROUP GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010149380 . This is a "VIRGINIA MEDICAID BRCC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 217324 . This is a "ANTHEM PROF TRIGON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 334969 . This is a "VALUEOPTIONS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4013483 . This is a "MAGELLAN NAVIGATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CORPHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 269963 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010149371 . This is a "VIRGINIA MEDICAID JOHNSON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4013483 . This is a "MAGELLAN SUMMIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4013483 . This is a "MAGELLAN PINNACLE" identifier . This identifiers is of the category "OTHER".




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