Healthcare Provider Details

I. General information

NPI: 1396408589
Provider Name (Legal Business Name): JENNY MARIE PEREZCHICA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W MAIN AVE STE 200
BISMARCK ND
58501-3871
US

IV. Provider business mailing address

107 W MAIN AVE STE 200
BISMARCK ND
58501-3871
US

V. Phone/Fax

Practice location:
  • Phone: 701-353-5560
  • Fax: 701-299-9100
Mailing address:
  • Phone: 701-353-5560
  • Fax: 701-299-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10737120518
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10737120518
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: