Organization Active NPI

Jessica Perez Licensed Professional Clinical Counselor Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Corona, CA
National Provider Identifier
1194488866
Registry record updated Nov 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
JESSICA PEREZ LICENSED PROFESSIONAL CLINICAL COUNSELOR INC
Practice address
4740 Green River Rd
Corona, CA 92878-9185
Phone
(909) 835-9366
NPI assigned
Oct 19, 2021
Last updated
Nov 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessica Perez, LPCCNPI 1770096323
Title
Owner
Phone
(951) 212-3184

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

4740 Green River Rd
Corona, CA 92878-9185

Mailing address

4740 Green River Rd Ste 206a
Corona, CA 92878-9434
Phone (951) 212-3184

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250113000861 CA Part B Supplier - Clinic/Group Practice 1355879875 Receives reassigned benefits from 4 practitioners
Practice locations: Corona, CA

National Provider Directory

National Provider Directory

Locations

16000 Apple Valley Rd
#C511
Apple Valley, CA 92307

4740 Green River Rd
Corona, CA 92878
Phone (310) 970-4366

4740 Green River Rd
Ste 206A
Corona, CA 92878
Phone (909) 835-9366

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763337600000",
    "number": "1194488866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 GREEN RIVER RD STE 206A",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928789434",
            "telephone_number": "951-212-3184",
            "fax_number": "909-658-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 GREEN RIVER RD",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928789185",
            "telephone_number": "909-835-9366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSICA PEREZ LICENSED PROFESSIONAL CLINICAL COUNSELOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-19",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-212-3184",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.