Healthcare Provider Details

I. General information

NPI: 1225536246
Provider Name (Legal Business Name): MRS. JENNY TAMLYN PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E SAINT JOHNS AVE
AUSTIN TX
78752-2508
US

IV. Provider business mailing address

2502 ZACH SCOTT ST
AUSTIN TX
78723-5520
US

V. Phone/Fax

Practice location:
  • Phone: 512-961-5575
  • Fax:
Mailing address:
  • Phone: 832-443-1781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number78865
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: