Provider Demographics
NPI:1053568378
Name:PERRY, REBECCA (LMHC, LMFT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 E SUNRISE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8245
Mailing Address - Country:US
Mailing Address - Phone:954-546-1003
Mailing Address - Fax:
Practice Address - Street 1:795 E SUNRISE VIEW DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8245
Practice Address - Country:US
Practice Address - Phone:954-546-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
NC101YM0800X
FLMH8117101YM0800X
101YM0800X
FL106H00000X
SD106H00000X
CO101YM0800X
UT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist