| Jessica Perez Licensed Professional Clinical Counselor Inc | |
|
4740 Green River Rd Corona CA 92878-9185 | |
| (909) 835-9366 | |
| Not Available |
| Full Name | Jessica Perez Licensed Professional Clinical Counselor Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4740 Green River Rd, Corona, California |
| Authorized Official Name and Position | Jessica Perez (OWNER) |
| Authorized Official Contact | 9512123184 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessica Perez Licensed Professional Clinical Counselor Inc 4016 Twining St Riverside CA 92509-6762 Ph: (951) 212-3184 | Jessica Perez Licensed Professional Clinical Counselor Inc 4740 Green River Rd Corona CA 92878-9185 Ph: (909) 835-9366 |
| NPI Number | 1194488866 |
|---|---|
| Provider Enumeration Date | 10/19/2021 |
| Last Update Date | 08/08/2023 |
| Certification Date | 08/08/2023 |
| Medicare PECOS PAC ID | 1355879875 |
|---|---|
| Medicare Enrollment ID | O20250113000861 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194488866 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jessica Perez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770096323 PECOS PAC ID: 1254869787 Enrollment ID: I20250113001007 |
| Provider Name | Saira Deyanira Miranda |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407386725 PECOS PAC ID: 7416486212 Enrollment ID: I20250123001989 |
| Provider Name | Desiree Mclaughlin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1023431939 PECOS PAC ID: 2961931670 Enrollment ID: I20250124002901 |
| Provider Name | Becky Salas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447710975 PECOS PAC ID: 5799205159 Enrollment ID: I20250228001198 |
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