Provider Demographics
NPI:1245307149
Name:PERRA, ANN CAUSEY (LPC)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:CAUSEY
Last Name:PERRA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49083
Mailing Address - Country:US
Mailing Address - Phone:269-651-3902
Mailing Address - Fax:269-659-4874
Practice Address - Street 1:103 S FOURTH ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49083
Practice Address - Country:US
Practice Address - Phone:269-651-3902
Practice Address - Fax:269-659-4874
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001550101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6278673Medicaid