Provider Demographics
NPI:1063854461
Name:PERRY, DARIN (LMFT)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N BROADWAY ST
Mailing Address - Street 2:PO BOX 1472
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-2706
Mailing Address - Country:US
Mailing Address - Phone:208-782-3434
Mailing Address - Fax:208-782-1389
Practice Address - Street 1:60 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2706
Practice Address - Country:US
Practice Address - Phone:208-782-3434
Practice Address - Fax:208-782-1389
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-3682106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist