Provider Demographics
NPI:1992214597
Name:PERRY, JOANN (LMFT)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:11025 PIONEER TRL UNIT 110
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0250
Mailing Address - Country:US
Mailing Address - Phone:518-524-4977
Mailing Address - Fax:
Practice Address - Street 1:11025 PIONEER TRL
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0281
Practice Address - Country:US
Practice Address - Phone:518-524-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
101YM0800X
126094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health