Perris Chenelle Edwards McKenzie

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

121303 Issued in CA

Practice address

3068 Johnson Ave
Costa Mesa, CA 92626-2819

Phone

(714) 545-0644

NPI assigned

Aug 7, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Rite of Passage Adolescent Treatment Centers and Schools Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Santa Ana, CA
  • NPI 1770127359
  NPD

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

{
    "created_epoch": "1565136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1962057729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N TUSTIN AVE STE 120",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053879",
            "telephone_number": "714-617-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3068 JOHNSON AVE",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926262819",
            "telephone_number": "714-545-0644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS MCKENZIE",
        "first_name": "PERRIS",
        "middle_name": "CHENELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-07",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "121303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elysse Eaton
• Jada Eaton
• Rayven Eckenwiler
• Eclc Residence, Inc.
• Eclc Wake Forest Villa, Inc.
• Sara Elizabeth Edwards
• Egb Holdings
• Egb Holdings
• Lorena Egea
• Catalina Egenolf

• Marriage & Family Therapist in Costa Mesa, CA
• Providers in Costa Mesa, 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 Apr 16, 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.