Provider Demographics
NPI:1851693014
Name:PERRY, KARIN RENE'
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:RENE'
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KARIN
Other - Middle Name:PERRY
Other - Last Name:KAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:116 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8907
Mailing Address - Country:US
Mailing Address - Phone:601-383-1065
Mailing Address - Fax:
Practice Address - Street 1:401 FONTAINE PL
Practice Address - Street 2:SUITE 101
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5227
Practice Address - Country:US
Practice Address - Phone:601-383-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-21
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1873101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional