Provider Demographics
NPI:1235290073
Name:PERREAULT, EDWARD MYLES (PHD LMHC PMHC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MYLES
Last Name:PERREAULT
Suffix:
Gender:M
Credentials:PHD LMHC PMHC
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:MYLES
Other - Last Name:PARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:4059 WINDOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606
Mailing Address - Country:US
Mailing Address - Phone:352-666-0066
Mailing Address - Fax:352-666-0066
Practice Address - Street 1:6169 DELTONA BLVD
Practice Address - Street 2:CASTIGNOLI COURT IV
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606
Practice Address - Country:US
Practice Address - Phone:352-592-2828
Practice Address - Fax:352-666-0066
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH 732101YM0800X
MAMHC 329101YM0800X
CTLPC 001127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health