Basic Information
Provider Information
NPI: 1043411630
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERRY
FirstName: DAVID
MiddleName: R
NamePrefix: MR.
NameSuffix:  
Credential: RC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1600 E OLIVE ST
Address2: SOUND MENTAL HEALTH
City: SEATTLE
State: WA
PostalCode: 981222735
CountryCode: US
TelephoneNumber: 2063022200
FaxNumber: 2063022210
Practice Location
Address1: 1314 8TH ST NE
Address2: SUITE 103
City: AUBURN
State: WA
PostalCode: 980024587
CountryCode: US
TelephoneNumber: 2538767600
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/30/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XRC00053174WAY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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