Provider Demographics
NPI:1235235292
Name:PERRY, STEPHEN CARL (MSED LP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CARL
Last Name:PERRY
Suffix:
Gender:M
Credentials:MSED LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 7TH AVE E
Mailing Address - Street 2:BHSI LLC STE 101
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2496
Mailing Address - Country:US
Mailing Address - Phone:651-769-6437
Mailing Address - Fax:651-769-6426
Practice Address - Street 1:2497 7TH AVE E
Practice Address - Street 2:BHSI LLC STE 101
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2496
Practice Address - Country:US
Practice Address - Phone:651-769-6400
Practice Address - Fax:651-769-6449
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1998103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical