Provider Demographics
NPI:1982885455
Name:PERIYANAYAGAM, CHELLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHELLA
Middle Name:
Last Name:PERIYANAYAGAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-8009
Mailing Address - Country:US
Mailing Address - Phone:270-821-0480
Mailing Address - Fax:270-821-0057
Practice Address - Street 1:99 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-8009
Practice Address - Country:US
Practice Address - Phone:270-821-0480
Practice Address - Fax:270-821-0057
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2007-102103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist