Provider Demographics
NPI:1386894665
Name:PEERY, JOAN C
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:C
Last Name:PEERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 S 1ST ST APT 153
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7005
Mailing Address - Country:US
Mailing Address - Phone:802-999-2484
Mailing Address - Fax:
Practice Address - Street 1:3501 SOUTH FIRST STREET APT 153
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:802-999-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000740101YM0800X
FLMH9216101YM0800X
TX66018101YM0800X
MA6981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1001510OtherNHP
MA1319744Medicaid
MA8411OtherBMC