Healthcare Provider Details

I. General information

NPI: 1922074970
Provider Name (Legal Business Name): J. CHARLENE PERRYMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 A LIGGIT AVE.
FT. LEWIS WA
98433
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER ATTN:MCHJ-DA
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-967-1442
  • Fax: 253-967-1411
Mailing address:
  • Phone: 253-967-1442
  • Fax: 253-967-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00001190
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00006902
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: