Provider Demographics
NPI:1538445077
Name:PERRY, PATRICK R (LPCC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:PERRY
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 LOCKSLIE WAY
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2243
Mailing Address - Country:US
Mailing Address - Phone:952-288-8505
Mailing Address - Fax:
Practice Address - Street 1:7050 LOCKSLIE WAY
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2243
Practice Address - Country:US
Practice Address - Phone:952-288-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00242101YM0800X
OHE.0501253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health