Provider Demographics
NPI:1477253243
Name:PERRYMAN, EDMUND JR
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:PERRYMAN
Suffix:JR
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 1:1651 RESPONSE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-5254
Mailing Address - Country:US
Mailing Address - Phone:916-642-9522
Mailing Address - Fax:916-678-4138
Practice Address - Street 1:1651 RESPONSE RD STE 111
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-5254
Practice Address - Country:US
Practice Address - Phone:916-642-9522
Practice Address - Fax:916-678-4138
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132583106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist