Provider Demographics
NPI:1205510260
Name:PERRY, MEGAN NICOLE FAYE (MAMHC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE FAYE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MAMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:OR
Mailing Address - Zip Code:97111-9628
Mailing Address - Country:US
Mailing Address - Phone:765-505-0248
Mailing Address - Fax:
Practice Address - Street 1:241 S PARK ST
Practice Address - Street 2:
Practice Address - City:CARLTON
Practice Address - State:OR
Practice Address - Zip Code:97111-9628
Practice Address - Country:US
Practice Address - Phone:765-505-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health