Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003236613 |
---|---|
Provider Name | Jennifer Perry |
First Address | Fort Wayne, IN 46805-3404 |
Second Address | Fort Wayne, IN 46805-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2014 |
Last Update Date | 22/04/2014 |