Provider Demographics
NPI:1396408589
Name:PEREZCHICA, JENNY MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:PEREZCHICA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N 3RD ST STE 250
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3860
Mailing Address - Country:US
Mailing Address - Phone:701-353-5560
Mailing Address - Fax:
Practice Address - Street 1:120 N 3RD ST STE 250
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3860
Practice Address - Country:US
Practice Address - Phone:701-353-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10737120518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health