MEDICARE: JEAN 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1801152301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN PERRY

Provider Business Mailing Address
First Line	:	2400 W DUNLAP AVE
Second Line	:	SUITE 300
City	:	PHOENIX
State	:	AZ
Zip	:	85021-2817
Country	:	US
Telephone Number	:	602-943-2999
Fax Number	:	602-943-4284

Provider Business Practice Location Address
First Line	:	2400 W DUNLAP AVE
Second Line	:	SUITE 300
City	:	PHOENIX
State	:	AZ
Zip	:	85021-2817
Country	:	US
Telephone Number	:	602-943-2999
Fax Number	:	602-943-4284

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

Provider Enumeration Date	:	04/09/2012
Last Update Date	:	04/09/2012

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Directions to “ JEAN PERRY ” Practice Location

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