=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043003635
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REMYA PERINCHERY PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2025
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 ROLLINS STREET
-----------------------------------------------------
City | COLUMBIA MO
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-882-6649
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 ROLLINS STREET 435 STRICKLAND HALL
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-456-0556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 2021050838
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------