Provider Demographics
NPI:1992151187
Name:PERRY, CYNTHIA A (MASTER OF SCIENCE)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:PERRY
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2592
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-2592
Mailing Address - Country:US
Mailing Address - Phone:405-394-0498
Mailing Address - Fax:
Practice Address - Street 1:910 S VIENNA ST STE 7
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5864
Practice Address - Country:US
Practice Address - Phone:318-224-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor