Provider Demographics
NPI:1306463047
Name:PERKINS, MOLLY (LAC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:PERKINS-INGLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 S LAKELINE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2719
Mailing Address - Country:US
Mailing Address - Phone:512-717-9080
Mailing Address - Fax:
Practice Address - Street 1:201 S LAKELINE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2719
Practice Address - Country:US
Practice Address - Phone:512-717-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01582171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist