MEDICARE: CODI PERRY

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
1	101Y00000X	Counselor	101791	TX

General Provider Information

NPI Number	:	1639009020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODI PERRY

Provider Business Mailing Address
First Line	:	9111 PORTOBELLO WAY
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-1578
Country	:	US
Telephone Number	:	720-771-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	9111 PORTOBELLO WAY
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-1578
Country	:	US
Telephone Number	:	210-570-7074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “ CODI PERRY ” Practice Location

Language	Start Address	Practice Location

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