Provider Demographics
NPI:1336538867
Name:PERDICES, JACKIE LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:LYNN
Last Name:PERDICES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8337 TELEGRAPH RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4957
Mailing Address - Country:US
Mailing Address - Phone:562-207-4272
Mailing Address - Fax:562-207-4279
Practice Address - Street 1:8337 TELEGRAPH RD STE 300
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4957
Practice Address - Country:US
Practice Address - Phone:562-207-4272
Practice Address - Fax:562-207-4279
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist