Provider Demographics
NPI:1053923177
Name:PERRY, MYLA (CLC, CD(DONA))
Entity type:Individual
Prefix:MRS
First Name:MYLA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:CLC, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6549 COACHLIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2050
Mailing Address - Country:US
Mailing Address - Phone:513-315-7350
Mailing Address - Fax:
Practice Address - Street 1:6549 COACHLIGHT WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2050
Practice Address - Country:US
Practice Address - Phone:513-549-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14839374J00000X
OH318728101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No374J00000XNursing Service Related ProvidersDoula