Healthcare Provider Details

I. General information

NPI: 1659014082
Provider Name (Legal Business Name): JESSICA PEREZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N ORANGE GROVE BLVD # 207
PASADENA CA
91103-3333
US

IV. Provider business mailing address

20600 VENTURA BLVD UNIT 1425
WOODLAND HILLS CA
91364-6667
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone: 424-702-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: