Provider Demographics
NPI:1174858856
Name:PERRY, GAYLE (MA, UNLICENSED PSYCH)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:MA, UNLICENSED PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4585 HILTON PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3569
Mailing Address - Country:US
Mailing Address - Phone:888-600-1088
Mailing Address - Fax:719-599-4693
Practice Address - Street 1:4585 HILTON PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3569
Practice Address - Country:US
Practice Address - Phone:888-600-1088
Practice Address - Fax:719-599-4693
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO7995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7995OtherCOLORADO STATE DEPARTMENT OF REGULATORY AGENCIES