Provider Demographics
NPI:1225536246
Name:PERRY, JENNY TAMLYN
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:TAMLYN
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 ZACH SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-5520
Mailing Address - Country:US
Mailing Address - Phone:832-443-1781
Mailing Address - Fax:
Practice Address - Street 1:500 E SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-2508
Practice Address - Country:US
Practice Address - Phone:512-961-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78865101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50788OtherCPH & ASSOCIATES