Provider Demographics
NPI:1194485177
Name:PERRY, JASON LAMAR (MED, ALC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LAMAR
Last Name:PERRY
Suffix:
Gender:M
Credentials:MED, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-4140
Mailing Address - Country:US
Mailing Address - Phone:205-447-9146
Mailing Address - Fax:
Practice Address - Street 1:2100A SOUTHBRIDGE PKWY STE 650
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-1377
Practice Address - Country:US
Practice Address - Phone:205-236-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3749A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor