Provider Demographics
NPI:1760074686
Name:PERRY, MISTY A (LCSW, CACIII)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:A
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 MIDPOINT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4306
Mailing Address - Country:US
Mailing Address - Phone:970-498-7488
Mailing Address - Fax:
Practice Address - Street 1:2255 MIDPOINT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4306
Practice Address - Country:US
Practice Address - Phone:970-498-7488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC0006921101YA0400X
COCSW000020241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)