Provider Demographics
NPI:1821135484
Name:PERRY, LINDA ANN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460-0746
Mailing Address - Country:US
Mailing Address - Phone:707-964-1329
Mailing Address - Fax:707-964-1329
Practice Address - Street 1:1102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5305
Practice Address - Country:US
Practice Address - Phone:707-964-1329
Practice Address - Fax:707-964-1329
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist