Provider Demographics
NPI:1710452131
Name:PERRY, KANEISHA RENEE
Entity Type:Individual
Prefix:
First Name:KANEISHA
Middle Name:RENEE
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1557
Mailing Address - Country:US
Mailing Address - Phone:832-865-6792
Mailing Address - Fax:
Practice Address - Street 1:15703 LONGENBAUGH DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1605
Practice Address - Country:US
Practice Address - Phone:832-427-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87941OtherTBHEC (LICENSED PROFESSIONAL COUNSELOR)