Provider Demographics
NPI:1689449399
Name:PERKINS, JOHN THACKER (LADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THACKER
Last Name:PERKINS
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3724
Mailing Address - Country:US
Mailing Address - Phone:612-472-9572
Mailing Address - Fax:
Practice Address - Street 1:1925 1ST AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3724
Practice Address - Country:US
Practice Address - Phone:612-472-9572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)