Provider Demographics
NPI:1780402123
Name:PERRY, DAKOTA JAMES
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:JAMES
Last Name:PERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 COUNTY ROAD 7310 LOT 15
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-8009
Mailing Address - Country:US
Mailing Address - Phone:806-252-4439
Mailing Address - Fax:
Practice Address - Street 1:6102 82ND ST STE 10
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0802
Practice Address - Country:US
Practice Address - Phone:806-993-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician