Healthcare Provider Details

I. General information

NPI: 1154957504
Provider Name (Legal Business Name): MRS. JOY PERRYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 NE 77TH AVE STE 275
VANCOUVER WA
98662-6857
US

IV. Provider business mailing address

4940 NW SIERRA CT
CAMAS WA
98607-9110
US

V. Phone/Fax

Practice location:
  • Phone: 360-903-8101
  • Fax:
Mailing address:
  • Phone: 360-903-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60996057
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: