Provider Demographics
NPI:1043777691
Name:PERIE, JENNA ELIZABETH (CMS QMHS)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ELIZABETH
Last Name:PERIE
Suffix:
Gender:F
Credentials:CMS QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3187 TURKEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:45681-9761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46 E WATER ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2544
Practice Address - Country:US
Practice Address - Phone:937-403-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)