Provider Demographics
NPI:1659014082
Name:PEREZ, JESSICA (LMFT, APCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 CANOGA AVE APT 364
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2508
Mailing Address - Country:US
Mailing Address - Phone:424-702-2947
Mailing Address - Fax:
Practice Address - Street 1:31200 VIA COLINAS STE 202
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3955
Practice Address - Country:US
Practice Address - Phone:818-600-2034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134695106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist