Provider Demographics
NPI:1669203394
Name:PERRY, ANTHONY G SR (LCDC I)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:PERRY
Suffix:SR
Gender:M
Credentials:LCDC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 JOYCE LN
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-6028
Mailing Address - Country:US
Mailing Address - Phone:785-320-1263
Mailing Address - Fax:
Practice Address - Street 1:6880 S W.S YOUNG DR
Practice Address - Street 2:SUITE 104 D
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542
Practice Address - Country:US
Practice Address - Phone:254-540-6729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17359101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)