Provider Demographics
NPI:1285837435
Name:PERRY, G. STEPHEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:STEPHEN
Last Name:PERRY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 BRECKENRIDGE LN STE 5
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5730
Mailing Address - Country:US
Mailing Address - Phone:502-493-7788
Mailing Address - Fax:
Practice Address - Street 1:3103 BRECKENRIDGE LN STE 5
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5730
Practice Address - Country:US
Practice Address - Phone:502-493-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1163103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling