Provider Demographics
NPI:1558401778
Name:PERRY, LORRAINE MADONNA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:MADONNA
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:BALLUFF PERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:804 NW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4930
Mailing Address - Country:US
Mailing Address - Phone:580-355-6494
Mailing Address - Fax:580-355-6494
Practice Address - Street 1:804 NW 44TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4930
Practice Address - Country:US
Practice Address - Phone:580-355-6494
Practice Address - Fax:580-355-6494
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional