Provider Demographics
NPI:1760609424
Name:PERRY, ANNETTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 LOMA LINDA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-3137
Mailing Address - Country:US
Mailing Address - Phone:210-735-0880
Mailing Address - Fax:
Practice Address - Street 1:94 BRIGGS ST
Practice Address - Street 2:700
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1221
Practice Address - Country:US
Practice Address - Phone:210-923-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional