Provider Demographics
NPI:1225609092
Name:PERRY, BRANDON WILLIAM (PRS)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:WILLIAM
Last Name:PERRY
Suffix:
Gender:M
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-1143
Mailing Address - Country:US
Mailing Address - Phone:937-544-5547
Mailing Address - Fax:937-544-3035
Practice Address - Street 1:923 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1143
Practice Address - Country:US
Practice Address - Phone:937-544-5547
Practice Address - Fax:937-544-3035
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175494101YA0400X
OHCDCA.180850101YA0400X
OH101YM0800X, 171M00000X
OH0002244175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator