MEDICARE: DANIESHA 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
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor	6798	WI
3	101YM0800X	Mental Health Counselor	6798	WI

General Provider Information

NPI Number	:	1720434335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIESHA PERRY LPC

Provider Business Mailing Address
First Line	:	7440 W GREENFIELD AVE UNIT 14181
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-6106
Country	:	US
Telephone Number	:	262-612-3443
Fax Number	:

Provider Business Practice Location Address
First Line	:	10025 W GREENFIELD AVE STE 110
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-3956
Country	:	US
Telephone Number	:	262-612-3443
Fax Number	:

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

Provider Enumeration Date	:	05/12/2016
Last Update Date	:	04/26/2022

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Directions to “ DANIESHA PERRY LPC” Practice Location

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