C Jill Pesavento, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

50471 Issued in CA

Practice address

11555 Los Osos Valley Rd
Suite 203
San Luis Obispo, CA 93405-6472

Phone

(805) 440-8555

Fax

(805) 771-9189

NPI assigned

Feb 11, 2015

Last updated

Feb 11, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423612800000",
    "number": "1336530492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11555 LOS OSOS VALLEY RD",
            "address_2": "SUITE 203",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934056472",
            "telephone_number": "805-440-8555",
            "fax_number": "805-771-9189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11555 LOS OSOS VALLEY RD",
            "address_2": "SUITE 203",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934056472",
            "telephone_number": "805-440-8555",
            "fax_number": "805-771-9189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESAVENTO",
        "first_name": "C",
        "middle_name": "JILL",
        "name_prefix": "Ms.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-11",
        "last_updated": "2015-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "50471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "50471",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Samantha Adrianna Perez, MSW
• Victor Perez
• Kyle Perkins
• Mona Jean Perkins, LMFT
• Peter C. Nelson DDS, Inc.
• Joshua Michael Peters, LMFT
• Sarah J Peters
• Austin Petersen
• Matthew Petersen, DO

• Marriage & Family Therapist in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.