Healthcare Provider Details

I. General information

NPI: 1376649376
Provider Name (Legal Business Name): WESLEY G PERDUE MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 S FOREST AVE
TEMPE AZ
85281
US

IV. Provider business mailing address

385 E CORONADO RD UNIT #2
PHOENIX AZ
85004-1504
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-6146
  • Fax: 480-965-3426
Mailing address:
  • Phone: 602-369-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-10598
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: