Individual provider Active NPI

Jasmine Renee Pedroza, LCSW

  • Counselor
  • McKinleyville, CA
National Provider Identifier
1205530987
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
108968 Issued in CA
Practice address
1560 Betty CT Ste a
McKinleyville, CA 95519-4406
Phone
(707) 839-1933
NPI assigned
Mar 28, 2023
Last updated
May 18, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 108968 CA Primary

Addresses

Primary practice location

1560 Betty CT Ste a
McKinleyville, CA 95519-4406

Mailing address

1560 Betty CT Ste a
McKinleyville, CA 95519-4406
Phone (707) 839-1933

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
108968CAMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Two Feathers Native American Family Services CurrentSince Apr 6, 2023 Accepting new patients
Two Feathers Native American Family Services PastSince Apr 6, 2023 Accepting new patients

Locations

1560 Betty Ct
Ste A
McKinleyville, CA 95519
Phone (707) 672-5549

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1205530987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 BETTY CT STE A",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955194406",
            "telephone_number": "707-839-1933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 BETTY CT STE A",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955194406",
            "telephone_number": "707-839-1933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDROZA",
        "first_name": "JASMINE",
        "middle_name": "RENEE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-28",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CA",
            "license": "108968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinleyville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.