Provider Demographics
NPI:1891330841
Name:PERRY, LISA (BSM, MAG, CDD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:BSM, MAG, CDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 S ALMA SCHOOL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-4400
Mailing Address - Country:US
Mailing Address - Phone:480-454-5674
Mailing Address - Fax:
Practice Address - Street 1:2705 S ALMA SCHOOL RD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-4400
Practice Address - Country:US
Practice Address - Phone:480-454-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty