Provider Demographics
NPI:1114024783
Name:PERRIN, GARY RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RAY
Last Name:PERRIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:527 MARQUETTE AVE
Mailing Address - Street 2:SUITE 1620
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-1302
Mailing Address - Country:US
Mailing Address - Phone:612-317-0665
Mailing Address - Fax:612-317-1017
Practice Address - Street 1:527 MARQUETTE AVE
Practice Address - Street 2:SUITE 1620
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-1302
Practice Address - Country:US
Practice Address - Phone:612-317-0665
Practice Address - Fax:612-317-1017
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP305103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical