Provider Demographics
NPI:1225365414
Name:PERRY, DARLA JEAN (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:JEAN
Last Name:PERRY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:OK
Mailing Address - Zip Code:73669-0432
Mailing Address - Country:US
Mailing Address - Phone:580-661-2937
Mailing Address - Fax:580-661-3030
Practice Address - Street 1:517 E ROH ST
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:OK
Practice Address - Zip Code:73669-7427
Practice Address - Country:US
Practice Address - Phone:580-661-2937
Practice Address - Fax:580-661-3030
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional