Trisa Marie Pederson

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

152294 Issued in CA

Practice address

17800 US Highway 18
Apple Valley, CA 92307-1221

Phone

(760) 552-6700

NPI assigned

Nov 16, 2018

Last updated

Dec 30, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• San Bernardino County Superintendent of Schools

  • Community/Behavioral Health Agency
  • Apple Valley, CA
  • NPI 1518091966
  NPD (past)
• Serene Health

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1649809526
  NPD (past)

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

{
    "created_epoch": "1542326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1346719556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17800 US HIGHWAY 18",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071221",
            "telephone_number": "760-552-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17800 US HIGHWAY 18",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071221",
            "telephone_number": "760-552-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "TRISA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-16",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "152294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul J Wisniewski DO Inc
• Paul Kim Optometry Apple Valley a Professional Corporation
• Stephanie Pavlik, DNP, APRN, FNP-C
• Jackie Kay Pavloski-Carter, MS,CCC,SLP
• Gloria Anne Peak, FNP
• Cynthia Edith Pedroza
• Veronica Jasmine Pelayo, OTD, OTR/L, CNS
• Anthony Pence, RN
• Nicole Marie Peralta
• Angelica Perea

• Marriage & Family Therapist in Apple Valley, CA
• Providers in Apple Valley, 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 Dec 30, 2024; 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.