Provider Demographics
NPI:1376267872
Name:PERRY SANDERFORD PLLC
Entity Type:Organization
Organization Name:PERRY SANDERFORD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:SANDERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-506-3217
Mailing Address - Street 1:1578 HIGHWAY 471
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-7511
Mailing Address - Country:US
Mailing Address - Phone:601-506-3217
Mailing Address - Fax:
Practice Address - Street 1:1578 HIGHWAY 471
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-7511
Practice Address - Country:US
Practice Address - Phone:601-506-3217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty