Provider Demographics
NPI:1932463973
Name:PERRKY, DEBRA CHAVEZ (LSAC INTERN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:CHAVEZ
Last Name:PERRKY
Suffix:
Gender:F
Credentials:LSAC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-2725
Mailing Address - Country:US
Mailing Address - Phone:801-359-8510
Mailing Address - Fax:801-532-2280
Practice Address - Street 1:411 GRANT ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-2725
Practice Address - Country:US
Practice Address - Phone:801-359-8510
Practice Address - Fax:801-532-2280
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)