Provider Demographics
NPI:1659593630
Name:PERRITT, LEA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:JEAN
Last Name:PERRITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 WEST VINE STREET
Mailing Address - Street 2:SUITE 1904
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1834
Mailing Address - Country:US
Mailing Address - Phone:859-253-9819
Mailing Address - Fax:502-564-6050
Practice Address - Street 1:369 WEST VINE STREET
Practice Address - Street 2:SUITE 1904
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1834
Practice Address - Country:US
Practice Address - Phone:859-253-9819
Practice Address - Fax:502-564-6050
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0521103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service