Provider Demographics
NPI:1497642482
Name:PERREAULT, LYDIA ELIZABETH
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ELIZABETH
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:ELIZABETH
Other - Last Name:PERREAULT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 HICKORY CLUB DR # 1808
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-6123
Mailing Address - Country:US
Mailing Address - Phone:432-203-0071
Mailing Address - Fax:
Practice Address - Street 1:1897 GENERAL GEORGE PATTON DR STE 108
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6232
Practice Address - Country:US
Practice Address - Phone:615-852-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-21
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician