Healthcare Provider Details

I. General information

NPI: 1487049854
Provider Name (Legal Business Name): BEN PERRY LPCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 ENTERPRISE DR
SOMERSET KY
42501-6155
US

IV. Provider business mailing address

149 ENTERPRISE DR
SOMERSET KY
42501-6155
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-6995
  • Fax:
Mailing address:
  • Phone: 606-679-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCCA00218287
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: