Provider Demographics
NPI:1790923993
Name:ENGSTROM, PERRY HAROLD III (LMSW)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:HAROLD
Last Name:ENGSTROM
Suffix:III
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 E LIBERTY ST
Mailing Address - Street 2:STE. 214
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2288
Mailing Address - Country:US
Mailing Address - Phone:734-665-7422
Mailing Address - Fax:
Practice Address - Street 1:527 E LIBERTY ST
Practice Address - Street 2:STE. 214
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2288
Practice Address - Country:US
Practice Address - Phone:734-665-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801061702104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker