Provider Demographics
NPI:1023395407
Name:PERRY, MISSY YOUNG (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MISSY
Middle Name:YOUNG
Last Name:PERRY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8490 WOODBURY XING
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9433
Mailing Address - Country:US
Mailing Address - Phone:651-739-1128
Mailing Address - Fax:763-271-2707
Practice Address - Street 1:8490 WOODBURY XING
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9433
Practice Address - Country:US
Practice Address - Phone:651-739-1128
Practice Address - Fax:763-271-2707
Is Sole Proprietor?:No
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist