Provider Demographics
NPI:1548694441
Name:PERRY, JOHN R (MA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:PERRY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N BROOKHURST ST
Mailing Address - Street 2:SUITE 136
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5637
Mailing Address - Country:US
Mailing Address - Phone:714-533-7749
Mailing Address - Fax:714-533-7749
Practice Address - Street 1:421 N BROOKHURST ST
Practice Address - Street 2:SUITE 136
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5637
Practice Address - Country:US
Practice Address - Phone:714-533-7749
Practice Address - Fax:714-533-7749
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44803106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist