Healthcare Provider Details

I. General information

NPI: 1376835942
Provider Name (Legal Business Name): MS. MEREDITH RICHARDS PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4197 NW 86TH TER
GAINESVILLE FL
32606-9278
US

IV. Provider business mailing address

PO BOX 100183
GAINESVILLE FL
32610-0183
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-4357
  • Fax:
Mailing address:
  • Phone: 352-392-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH20858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: