Provider Demographics
NPI:1538409198
Name:PERRY, MOLLY (LPCC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2929
Mailing Address - Country:US
Mailing Address - Phone:612-432-3525
Mailing Address - Fax:952-920-9323
Practice Address - Street 1:5407 EXCELSIOR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2929
Practice Address - Country:US
Practice Address - Phone:612-432-3525
Practice Address - Fax:952-920-9323
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional