Provider Demographics
NPI:1235359878
Name:PERKINS, TINA PATRO (MED, LPCC)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:PATRO
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-2106
Mailing Address - Country:US
Mailing Address - Phone:606-621-5134
Mailing Address - Fax:606-621-5074
Practice Address - Street 1:112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2106
Practice Address - Country:US
Practice Address - Phone:606-621-5134
Practice Address - Fax:606-621-5074
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103795101YM0800X
KY1489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY103795OtherLICENSE