Provider Demographics
NPI:1194233353
Name:PERRY, KALICIA (LPC)
Entity type:Individual
Prefix:
First Name:KALICIA
Middle Name:
Last Name:PERRY
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 1:23250 CHAGRIN BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5445
Mailing Address - Country:US
Mailing Address - Phone:216-464-4243
Mailing Address - Fax:
Practice Address - Street 1:23250 CHAGRIN BLVD STE 425
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5445
Practice Address - Country:US
Practice Address - Phone:216-464-4243
Practice Address - Fax:216-595-8210
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1800934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty