Provider Demographics
NPI:1215178363
Name:PERRY, NATHAN (BA)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SW COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1353
Mailing Address - Country:US
Mailing Address - Phone:541-757-8068
Mailing Address - Fax:541-758-1030
Practice Address - Street 1:4515 SW COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1353
Practice Address - Country:US
Practice Address - Phone:541-757-8068
Practice Address - Fax:541-758-1030
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker