Provider Demographics
NPI:1730636374
Name:PEREZ, JESSE M (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 FERNLEAF DRVIE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8996
Mailing Address - Country:US
Mailing Address - Phone:815-814-7475
Mailing Address - Fax:
Practice Address - Street 1:1242 FERNLEAF DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8996
Practice Address - Country:US
Practice Address - Phone:815-814-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL180013206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180013206OtherSTATE OF ILLINOIS DEPARTMENT OF FINACIAL AND PROFESSIONAL REGULATION