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NPI Code Detail

MEDICARE: MR. JAMES PERRY LPC

MEDICARE: MR. JAMES PERRY LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor7802OK

General Provider Information

NPI Number : 1003208919
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES PERRY LPC
Provider Business Mailing Address
First Line : 11428 NW 105TH ST
Second Line :
City : YUKON
State : OK
Zip : 73099-1723
Country : US
Telephone Number : 405-694-9477
Fax Number :
Provider Business Practice Location Address
First Line : 5705 NW 132ND ST STE 5
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-4437
Country : US
Telephone Number : 405-694-9477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2015
Last Update Date : 12/01/2021

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