Basic Information
| Provider Information | |||||||||
| NPI: | 1376649376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERDUE | ||||||||
| FirstName: | WESLEY | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MS, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 385 E CORONADO RD | ||||||||
| Address2: | UNIT #2 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023698720 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1151 S FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809656146 | ||||||||
| FaxNumber: | 4809653426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 02/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-10598 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.