Provider Demographics
NPI:1891922720
Name:PERRY, TYANNE C
Entity Type:Individual
Prefix:MISS
First Name:TYANNE
Middle Name:C
Last Name:PERRY
Suffix:
Gender:F
Credentials:
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 M
Mailing Address - Street 2:504 MICAH DRIVE
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-0913
Mailing Address - Country:US
Mailing Address - Phone:618-395-4306
Mailing Address - Fax:618-395-4507
Practice Address - Street 1:PO BOX M
Practice Address - Street 2:504 MICAH DRIVE
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-0913
Practice Address - Country:US
Practice Address - Phone:618-395-4306
Practice Address - Fax:618-395-4507
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor