Active NPI
Jennifer Fuentes Perez, PSY.D.
- Clinical Psychologist
- Mustang, OK
National Provider Identifier
1851639207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY12114
- Practice address
- 5305 Malpaso Creek Dr
Mustang, OK 73064-4881 - Phone
- (843) 304-1431
- NPI assigned
- Jan 18, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY12114 | FL | Primary |
| Clinical Psychologist | 103TC0700X | 004555 | PR |
Addresses
Primary practice location
5305 Malpaso Creek Dr
Mustang, OK 73064-4881
Mailing address
6421 N Florida Ave
D-557
Tampa, FL 33604
Phone (843) 304-1431
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
| License | State | Type | Specialty |
|---|---|---|---|
| PY12114 | FL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Carolina Dept of Mental Health Accounting Office | Past | Accepting new patients | |
| South Carolina Dept of Mental Health Accounting Office | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Columbia, SC
- NPI 1083421994
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Bennetsville, SC
- NPI 1609979640
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705881600000",
"number": "1851639207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6421 N FLORIDA AVE",
"address_2": "D-557",
"city": "TAMPA",
"state": "FL",
"postal_code": "33604",
"telephone_number": "843-304-1431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5305 MALPASO CREEK DR",
"city": "MUSTANG",
"state": "OK",
"postal_code": "730644881",
"telephone_number": "843-304-1431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES PEREZ",
"first_name": "JENNIFER",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-18",
"last_updated": "2024-01-22",
"certification_date": "2024-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY12114",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "004555",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mustang, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.