Provider Demographics
NPI:1114670098
Name:PERRY, BRIAN SR (LPC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PERRY
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4706
Mailing Address - Country:US
Mailing Address - Phone:214-728-8665
Mailing Address - Fax:
Practice Address - Street 1:680 US HIGHWAY 80 EAST, MESQUITE TX 75149
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:214-728-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional