Provider Demographics
NPI:1356908651
Name:PERRY, NATHAN NEAL (LLMSW, DP-C, ADS)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:NEAL
Last Name:PERRY
Suffix:
Gender:M
Credentials:LLMSW, DP-C, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4287 FIVE OAKS DRIVE
Mailing Address - Street 2:BEHAVIORAL HEALTH DIVISION
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4214
Mailing Address - Country:US
Mailing Address - Phone:517-882-4000
Mailing Address - Fax:517-882-3506
Practice Address - Street 1:1033 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1058
Practice Address - Country:US
Practice Address - Phone:517-543-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801104363101YA0400X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker