Provider Demographics
NPI:1114141587
Name:PERRIN, GARY I (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:I
Last Name:PERRIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 E BROADWAY BLVD
Mailing Address - Street 2:SUITE 720
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3705
Mailing Address - Country:US
Mailing Address - Phone:520-790-5200
Mailing Address - Fax:520-790-5175
Practice Address - Street 1:5151 E BROADWAY BLVD
Practice Address - Street 2:SUITE 720
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3705
Practice Address - Country:US
Practice Address - Phone:520-790-5200
Practice Address - Fax:520-790-5175
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1636103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic