MEDICARE: PERRY COLLONGE MA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	T1285	OR

General Provider Information

NPI Number	:	1245873918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERRY COLLONGE MA, LMFT

Provider Business Mailing Address
First Line	:	408 N LAUREL ST
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1113
Country	:	US
Telephone Number	:	408-656-1219
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 N LAUREL ST
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1113
Country	:	US
Telephone Number	:	408-656-1219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	04/18/2025

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