Provider Demographics
NPI:1669725735
Name:MARGARET M PERISH
Entity type:Organization
Organization Name:MARGARET M PERISH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERISH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:972-832-1192
Mailing Address - Street 1:211 ROCKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4211
Mailing Address - Country:US
Mailing Address - Phone:972-832-1192
Mailing Address - Fax:972-698-8934
Practice Address - Street 1:3600 GUS THOMASSON RD
Practice Address - Street 2:SUITE 146
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6200
Practice Address - Country:US
Practice Address - Phone:972-832-1192
Practice Address - Fax:972-698-8934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36230261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center