Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 15750 | TX |
NPI | 1003156787 |
---|---|
Provider Name | Ms. Juanita Annette Perry |
First Address | Houston, TX 77099-2302 |
Second Address | Houston, TX 77099-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2013 |
Last Update Date | 18/02/2013 |