Provider Demographics
NPI:1609294610
Name:PERRY, NATASHA NICOLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:NICOLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 LAPIS LN
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5425
Mailing Address - Country:US
Mailing Address - Phone:850-333-3103
Mailing Address - Fax:
Practice Address - Street 1:6230 LAPIS LN
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5425
Practice Address - Country:US
Practice Address - Phone:850-333-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst