Provider Demographics
NPI:1386762854
Name:PERRY, JONATHAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 N. GREEN ACRES RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-966-4406
Mailing Address - Fax:479-444-6770
Practice Address - Street 1:2013 N. GREEN ACRES RD
Practice Address - Street 2:SUITE C
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-966-4406
Practice Address - Fax:479-444-6770
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR87-05P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical