Provider Demographics
NPI:1669500468
Name:PERKIN, CHRISTOPHER JOHN (MS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:PERKIN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:JOHN
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:14515 HAMLIN ST
Mailing Address - Street 2:200
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1608
Mailing Address - Country:US
Mailing Address - Phone:818-373-4993
Mailing Address - Fax:818-780-0617
Practice Address - Street 1:14515 HAMLIN ST
Practice Address - Street 2:200
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1608
Practice Address - Country:US
Practice Address - Phone:818-373-4993
Practice Address - Fax:818-780-0617
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7068Medicaid
CA7420Medicaid