Healthcare Provider Details

I. General information

NPI: 1982118816
Provider Name (Legal Business Name): KAREN LOUISE PERRY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58945 BUSINESS CENTER DR
YUCCA VALLEY CA
92284-7307
US

IV. Provider business mailing address

311 DELGADA AVE
YUCCA VALLEY CA
92284
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-9657
  • Fax:
Mailing address:
  • Phone: 760-285-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number42178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: