Provider Demographics
NPI:1376649376
Name:PERDUE, WESLEY G (MS, LPC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:G
Last Name:PERDUE
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 E CORONADO RD
Mailing Address - Street 2:UNIT #2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1504
Mailing Address - Country:US
Mailing Address - Phone:602-369-8720
Mailing Address - Fax:
Practice Address - Street 1:1151 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281
Practice Address - Country:US
Practice Address - Phone:480-965-6146
Practice Address - Fax:480-965-3426
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional