Provider Demographics
NPI:1306991732
Name:PERINI, JOHNNY LYNN (PSYD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:LYNN
Last Name:PERINI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 BYRON AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2877
Mailing Address - Country:US
Mailing Address - Phone:360-733-9226
Mailing Address - Fax:360-733-9117
Practice Address - Street 1:1050 LARRABEE AVE STE 204
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7367
Practice Address - Country:US
Practice Address - Phone:360-733-9226
Practice Address - Fax:360-734-9117
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002079103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical