Healthcare Provider Details

I. General information

NPI: 1326966961
Provider Name (Legal Business Name): TYRAH PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11216 IRWIN OAK PL
MATTHEWS NC
28105-4246
US

IV. Provider business mailing address

11216 IRWIN OAK PL
MATTHEWS NC
28105-4246
US

V. Phone/Fax

Practice location:
  • Phone: 704-560-4830
  • Fax:
Mailing address:
  • Phone: 704-560-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number163259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: