Provider Demographics
NPI:1407670805
Name:PERRY, TENNILLE (LPC)
Entity type:Individual
Prefix:
First Name:TENNILLE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3324
Mailing Address - Country:US
Mailing Address - Phone:708-256-8245
Mailing Address - Fax:
Practice Address - Street 1:9631 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3137
Practice Address - Country:US
Practice Address - Phone:773-234-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health