MEDICARE: DR. JENNIFER KATHRYN PEREIRA PHD, LPC, RPT-S,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	16425	AZ
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1194959106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER KATHRYN PEREIRA PHD, LPC, RPT-S,

Provider Business Mailing Address
First Line	:	6220 W CORONA DR
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-1184
Country	:	US
Telephone Number	:	352-262-2125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 E CHANDLER BLVD STE 107
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-6280
Country	:	US
Telephone Number	:	352-262-2125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	01/21/2025

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