Provider Demographics
NPI:1891884102
Name:PERRY, TIM A (LPC MHSP MA)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:A
Last Name:PERRY
Suffix:
Gender:M
Credentials:LPC MHSP MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 SPRATLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6205
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:26 MIDWAY ST
Practice Address - Street 2:BRISTOL REGIONAL COUNSELING CENTER
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-989-4500
Practice Address - Fax:423-989-4568
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC1447101Y00000X
TN1447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
351654200OtherDOL WORKERS COMP
620582605OtherTHREE RIVERS PROVI GROUP
620582605OtherHIGHLANDS WELLMONT
620582605OtherINITIAL GROUP GROUP
010149380OtherVIRGINIA MEDICAID BRCC
217324OtherANTHEM PROF TRIGON
334969OtherVALUEOPTIONS GROUP
4013483OtherMAGELLAN NAVIGATOR
620582605OtherBEECH STREET
620582605OtherCORPHEALTH
269963OtherCOMPSYCH
010149371OtherVIRGINIA MEDICAID JOHNSON
4013483OtherMAGELLAN SUMMIT
4013483OtherMAGELLAN PINNACLE