Provider Demographics
NPI:1508162868
Name:PERKINS, MALINDA JUNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:JUNE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4411 WASHINGTON AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0805
Mailing Address - Country:US
Mailing Address - Phone:812-479-1916
Mailing Address - Fax:812-479-5014
Practice Address - Street 1:4411 WASHINGTON AVE
Practice Address - Street 2:STE. 200
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0805
Practice Address - Country:US
Practice Address - Phone:812-479-1916
Practice Address - Fax:812-479-5014
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31821041C0700X
IN34005328A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100061874Medicare PIN