Berry, Preston Eugene
Berry, Preston Eugene is an sole proprietor health care provider with primary practice located at 1523 S. Fairmont Street , Davenport IA 52802-5351. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Berry, Preston Eugene can be contacted via phone (563) 322-2667.Contact Information
Primary practice address
1523 S. Fairmont Street
Davenport IA 52802-5351
Phone: (563) 322-2667
Fax: (563) 322-3671
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 7544 | Texas |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 11618-1121 | Texas |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 37377 | Illinois |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 21R028 | Iowa |
Profile Details
| NPI number | 1184873804 |
|---|---|
| LBN Legal business name | Berry, Preston Eugene |
| Credentials | IADC & CRADC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 17th, 2008 |
| Last updated | May 13th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184873804 | NPPES |
| Texas | Other | 11618-1121 | ICADC |
| Texas | Other | 7544 | ICADC |
| Texas | Other | 21R028 | ICADC |
| Texas | Other | 37377 | ICADC |
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