Provider Demographics
NPI:1063776433
Name:PERRY, VICKI R (PSYD)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:R
Last Name:PERRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6702 W POLY WEBB RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-3615
Mailing Address - Country:US
Mailing Address - Phone:817-478-0095
Mailing Address - Fax:
Practice Address - Street 1:6702 W POLY WEBB RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-3615
Practice Address - Country:US
Practice Address - Phone:817-478-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical