Provider Demographics
NPI:1063038784
Name:BLEVINS, JESSICA MARIE-PEDROZA (LMFT, ATR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE-PEDROZA
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41715 ENTERPRISE CIR N STE 106
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5623
Mailing Address - Country:US
Mailing Address - Phone:760-466-8860
Mailing Address - Fax:
Practice Address - Street 1:41715 ENTERPRISE CIR N STE 106
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5623
Practice Address - Country:US
Practice Address - Phone:619-500-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist