Provider Demographics
NPI:1376289850
Name:PERRY, LEWIS JAMES (LPC)
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:JAMES
Last Name:PERRY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4948
Mailing Address - Country:US
Mailing Address - Phone:315-264-9815
Mailing Address - Fax:
Practice Address - Street 1:1508 SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4948
Practice Address - Country:US
Practice Address - Phone:315-264-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008908101YM0800X
TN5797101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health