Individual provider Active NPI

Jill None Demos, PSY.D.

  • Mental Health Counselor
  • Perris, CA
National Provider Identifier
1205091790
Registry record updated Jul 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
PSY 15732 Issued in CA
Practice address
24050 Christmas Tree Lane
Perris, CA 92570
Phone
(951) 657-4096
Fax
(951) 657-8710
NPI assigned
Jul 23, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X PSY 15732 CA Primary

Addresses

Primary practice location

24050 Christmas Tree Lane
Perris, CA 92570

Mailing address

PO Box 279
Perris, CA 92572-0279
Phone (951) 657-4096

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY 15732CAMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216771200000",
    "number": "1205091790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925720279",
            "telephone_number": "951-657-4096",
            "fax_number": "951-657-8710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24050 CHRISTMAS TREE LANE",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "92570",
            "telephone_number": "951-657-4096",
            "fax_number": "951-657-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMOS",
        "first_name": "JILL",
        "middle_name": "NONE",
        "name_prefix": "Mrs.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-23",
        "last_updated": "2008-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "PSY 15732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perris, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.