Provider Demographics
NPI:1710080833
Name:MARCHIONI, PERRY M (PHD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:M
Last Name:MARCHIONI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 W ILLINOIS
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701
Mailing Address - Country:US
Mailing Address - Phone:432-684-4540
Mailing Address - Fax:432-685-0809
Practice Address - Street 1:1705 W ILLINOIS
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-684-4540
Practice Address - Fax:432-685-0809
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23560103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033438501Medicaid
TX00G25YMedicare ID - Type Unspecified