Provider Demographics
NPI:1235473323
Name:PERRY, JERMELL ANTONIO
Entity Type:Individual
Prefix:
First Name:JERMELL
Middle Name:ANTONIO
Last Name:PERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 S WESTERN AVE STE 707
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-4537
Mailing Address - Country:US
Mailing Address - Phone:405-922-6013
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE STE 707
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4537
Practice Address - Country:US
Practice Address - Phone:405-922-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor